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NPI Code Detail

MEDICARE: JOEL L PELAVIN MD PC

MEDICARE: JOEL L PELAVIN MD PC
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
1332H00000XEyewear SupplierJP042865MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1JP042865OTHERMIMEDICAL LICENSE NUMBER

General Provider Information

NPI Number : 1164559605
Entity Type Code : Organization
Provider Name (Legal Business Name) : JOEL L PELAVIN MD PC
Provider Business Mailing Address
First Line : 29750 HARPER AVE
Second Line :
City : SAINT CLAIR SHORES
State : MI
Zip : 48082-2607
Country : US
Telephone Number : 586-296-7770
Fax Number : 586-296-9617
Provider Business Practice Location Address
First Line : 29750 HARPER AVE
Second Line :
City : SAINT CLAIR SHORES
State : MI
Zip : 48082-2607
Country : US
Telephone Number : 586-296-7770
Fax Number : 586-296-9617
Authorized Official
Title or Position : BILLER
Name : MISS TRACY L HALPIN
Credential : C O A
Telephone Number : 586-296-7770
Provider Enumeration Date : 02/28/2007
Last Update Date : 04/20/2008

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