Healthcare Provider Details

I. General information

NPI: 1285690255
Provider Name (Legal Business Name): JOSEPH PETER FARRELL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 07/09/2020
Certification Date: 07/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 N ELM AVE
JACKSON MI
49202-3571
US

IV. Provider business mailing address

DEPARTMENT 272801 PO BOX 67000
DETROIT MI
48267-2728
US

V. Phone/Fax

Practice location:
  • Phone: 517-788-6760
  • Fax: 517-788-3029
Mailing address:
  • Phone: 517-841-6913
  • Fax: 517-841-6917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number34.007479
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number5101015920
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: