Healthcare Provider Details

I. General information

NPI: 1912998394
Provider Name (Legal Business Name): MARY JO K VOELPEL D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 01/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3003 S. BALDWIN RD. SUITE A
LAKE ORION MI
48359
US

IV. Provider business mailing address

P.O. BOX 318 3003 S. BALDWIN RD. SUITE A
LAKE ORION MI
48359
US

V. Phone/Fax

Practice location:
  • Phone: 248-391-9220
  • Fax: 248-391-9224
Mailing address:
  • Phone: 248-391-9220
  • Fax: 248-391-9224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMV006984
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: