Healthcare Provider Details

I. General information

NPI: 1881004539
Provider Name (Legal Business Name): MICHAEL ESPELAND
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2014
Last Update Date: 06/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 N EAST AVE
JACKSON MI
49201-1753
US

IV. Provider business mailing address

205 N EAST AVE ATTENTION: GRADUATE MEDICAL EDUCATION
JACKSON MI
49201
US

V. Phone/Fax

Practice location:
  • Phone: 517-205-4811
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD60888867
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: