Provider Demographics
NPI:1710915905
Name:POSTULA, JASON EDWARD (MD)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:EDWARD
Last Name:POSTULA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:JASON
Other - Middle Name:EDWARD
Other - Last Name:POSTULA-STEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:12660 TEN MILE RD # 2A
Mailing Address - Street 2:
Mailing Address - City:SOUTH LYON
Mailing Address - State:MI
Mailing Address - Zip Code:48178-9141
Mailing Address - Country:US
Mailing Address - Phone:810-895-4070
Mailing Address - Fax:833-972-1137
Practice Address - Street 1:12660 TEN MILE RD # 2A
Practice Address - Street 2:
Practice Address - City:SOUTH LYON
Practice Address - State:MI
Practice Address - Zip Code:48178-9141
Practice Address - Country:US
Practice Address - Phone:810-895-4070
Practice Address - Fax:833-972-1137
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301076568207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0H24978OtherBLUE CROSS BLUE SHIELD
MICG4894OtherMEDICARE RAILROAD
MI4244327Medicaid
MIH25817Medicare UPIN
MI4244327Medicaid