Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | CPO2466 | MI |
Y | 222Z00000X | Podiatrist | CPO2466 | MI |
NPI | 1003338898 |
---|---|
Provider Name | Mr. Joshua Paul Ahlstrom |
First Address | Jackson, MI 49202-3517 |
Second Address | Jackson, MI 49202-3517 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2017 |
Last Update Date | 12/07/2017 |