1679642540 NPI number — DR. JOCELYN M POULIOT M.D.

Table of content: DR. JOCELYN M POULIOT M.D. (NPI 1679642540)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679642540 NPI number — DR. JOCELYN M POULIOT M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
POULIOT
Provider First Name:
JOCELYN
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WESTER
Provider Other First Name:
JOCELYN
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1679642540
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/02/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9415 TAYLORS TURN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STANWOOD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49346-8812
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9415 TAYLORS TURN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STANWOOD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49346-8812
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
231-834-0444
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  JP049722 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 4301049722 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4264320 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1750472734 . This is a "GROUP NPI NUMBER" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1101318392 . This is a "BCBS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 381916607 . This is a "TAX ID" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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