MEDICARE: JOSEPH CLEARY

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	163W00000X	Registered Nurse	4704293792	MI

General Provider Information

NPI Number	:	1447705199
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH CLEARY

Provider Business Mailing Address
First Line	:	11844 CARLETON RD
Second Line	:
City	:	CLAYTON
State	:	MI
Zip	:	49235-9731
Country	:	US
Telephone Number	:	906-250-1747
Fax Number	:

Provider Business Practice Location Address
First Line	:	11844 CARLETON RD
Second Line	:
City	:	CLAYTON
State	:	MI
Zip	:	49235-9731
Country	:	US
Telephone Number	:	906-250-1747
Fax Number	:

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

Provider Enumeration Date	:	08/23/2016
Last Update Date	:	08/23/2016

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Directions to “ JOSEPH CLEARY ” Practice Location

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