Healthcare Provider Details

I. General information

NPI: 1134522980
Provider Name (Legal Business Name): JOSHUA PRIEHS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2014
Last Update Date: 10/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 W 13 MILE RD
MADISON HEIGHTS MI
48071-1858
US

IV. Provider business mailing address

608 W 13 MILE RD
MADISON HEIGHTS MI
48071-1858
US

V. Phone/Fax

Practice location:
  • Phone: 248-589-3943
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2601000115
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: