Healthcare Provider Details

I. General information

NPI: 1568924025
Provider Name (Legal Business Name): JOEL ROBERT MCCORMICK DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2019
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39650 ORCHARD HILL PL STE 100
NOVI MI
48375-5392
US

IV. Provider business mailing address

39650 ORCHARD HILL PL STE 100
NOVI MI
48375-5392
US

V. Phone/Fax

Practice location:
  • Phone: 248-449-7010
  • Fax: 248-449-7015
Mailing address:
  • Phone: 248-449-7010
  • Fax: 248-449-7015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number5101027924
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number5101027924
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: