Healthcare Provider Details

I. General information

NPI: 1700945284
Provider Name (Legal Business Name): JOE FLYNN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 05/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 HARRINGTON ST
MOUNT CLEMENS MI
48043-2920
US

IV. Provider business mailing address

PO BOX 8836
GRAND RAPIDS MI
49518-8836
US

V. Phone/Fax

Practice location:
  • Phone: 586-493-8000
  • Fax:
Mailing address:
  • Phone: 866-898-7139
  • Fax: 616-975-9824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number5101009741
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: