Healthcare Provider Details

I. General information

NPI: 1295665966
Provider Name (Legal Business Name): PROMED PREFERRED MI 4 PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

614 S ANNA ST
MT PLEASANT MI
48858-2812
US

IV. Provider business mailing address

329 S OYSTER BAY RD # 2059
PLAINVIEW NY
11803-3301
US

V. Phone/Fax

Practice location:
  • Phone: 615-499-3165
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: THOMAS JOKERST
Title or Position: PRESIDENT
Credential: DO
Phone: 615-499-3165