Provider Demographics
NPI:1770753691
Name:JEFFREY D JOSHOWITZ DO PC
Entity type:Organization
Organization Name:JEFFREY D JOSHOWITZ DO PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:D
Authorized Official - Last Name:JOSHOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-489-0766
Mailing Address - Street 1:39475 LEWIS DR
Mailing Address - Street 2:SUITE 140
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377-2981
Mailing Address - Country:US
Mailing Address - Phone:248-489-0766
Mailing Address - Fax:
Practice Address - Street 1:39475 LEWIS DR
Practice Address - Street 2:SUITE 140
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377-2981
Practice Address - Country:US
Practice Address - Phone:248-489-0766
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-06
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101010027207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4675316Medicaid
OP03350Medicare PIN
MI4675316Medicaid