MEDICARE: JOSEPH MIKE 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	208600000X	Surgery Physician	25MA05623000	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467453738
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH MIKE M.D.

Provider Business Mailing Address
First Line	:	2 EVES DR
Second Line	:	SUITE 109
City	:	MARLTON
State	:	NJ
Zip	:	08053-3193
Country	:	US
Telephone Number	:	856-669-6061
Fax Number	:	856-651-0853

Provider Business Practice Location Address
First Line	:	17 W RED BANK AVE
Second Line	:	SUITE 203
City	:	WOODBURY
State	:	NJ
Zip	:	08096-1630
Country	:	US
Telephone Number	:	856-848-8242
Fax Number	:	856-384-6015

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

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	03/24/2011

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