Provider Demographics
NPI:1871557462
Name:JOSEPH, DAVID L (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:L
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1500 ABBOT RD
Mailing Address - Street 2:SUITE #400
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-1222
Mailing Address - Country:US
Mailing Address - Phone:517-332-0100
Mailing Address - Fax:517-332-0356
Practice Address - Street 1:1500 ABBOT RD
Practice Address - Street 2:SUITE #400
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-1222
Practice Address - Country:US
Practice Address - Phone:517-332-0100
Practice Address - Fax:517-332-0356
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301027698174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3355484Medicaid
MI3355484Medicaid