Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | 062693 | MI |
NPI | 1134101959 |
---|---|
Provider Name | Jasmine Joseph |
First Address | Carol Stream, IL 60122-0021 |
Second Address | Marquette, MI 49855 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2005 |
Last Update Date | 21/04/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110095654 | RAILROAD MEDICARE (01) | MI |
3138375 | (05) | MI |
381358036011 | TRICARE (01) | MI |
F88734 | (02) |