Healthcare Provider Details

I. General information

NPI: 1255337689
Provider Name (Legal Business Name): JOEL C ENGEL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 06/06/2012
Certification Date:
Deactivation Date: 03/21/2006
Reactivation Date: 03/27/2006

III. Provider practice location address

18303 E 10 MILE RD SUITE 100
ROSEVILLE MI
48066-4988
US

IV. Provider business mailing address

18303 E 10 MILE RD SUITE 100
ROSEVILLE MI
48066-4988
US

V. Phone/Fax

Practice location:
  • Phone: 586-776-8877
  • Fax: 586-776-3092
Mailing address:
  • Phone: 586-776-8877
  • Fax: 586-776-3092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number8340
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: