1609871037 NPI number — DR. JOSEPH VINCENT GONZALEZ D.P.M.

Table of content: DR. JOSEPH VINCENT GONZALEZ D.P.M. (NPI 1609871037)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609871037 NPI number — DR. JOSEPH VINCENT GONZALEZ D.P.M.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GONZALEZ
Provider First Name:
JOSEPH
Provider Middle Name:
VINCENT
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.P.M.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609871037
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/24/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2843 E GRAND RIVER AVE
Provider Second Line Business Mailing Address:
# 235
Provider Business Mailing Address City Name:
EAST LANSING
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48823-6722
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-853-8951
Provider Business Mailing Address Fax Number:
517-913-5996

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2270 JOLLY OAK RD
Provider Second Line Business Practice Location Address:
STE 1
Provider Business Practice Location Address City Name:
OKEMOS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48864-4528
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-853-8951
Provider Business Practice Location Address Fax Number:
517-913-5996
Provider Enumeration Date:
06/13/2005

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: 213ES0103X , with the licence number:  5901002023 , 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)





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