MEDICARE: DR. JOHN LESLIE PAQUET M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	JP068616	MI

General Provider Information

NPI Number	:	1073593364
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN LESLIE PAQUET M.D.

Provider Business Mailing Address
First Line	:	1934 MONROE ST
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48124-2917
Country	:	US
Telephone Number	:	313-565-7464
Fax Number	:	313-565-3620

Provider Business Practice Location Address
First Line	:	1934 MONROE ST
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48124-2917
Country	:	US
Telephone Number	:	313-565-7464
Fax Number	:	313-565-3620

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/20/2006
Last Update Date	:	07/08/2007

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