Healthcare Provider Details

I. General information

NPI: 1497706410
Provider Name (Legal Business Name): JOSE PAEZ GONZALEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 11/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4444 W BRISTOL RD STE. 150
FLINT MI
48507-3153
US

IV. Provider business mailing address

PO BOX 1239
TROY MI
48099-1239
US

V. Phone/Fax

Practice location:
  • Phone: 810-230-9500
  • Fax: 810-230-0169
Mailing address:
  • Phone: 248-824-6600
  • Fax: 248-324-1477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301068202
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: