Healthcare Provider Details

I. General information

NPI: 1073607909
Provider Name (Legal Business Name): MICHAEL HENRY JOSEPH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 06/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5060 BRADENTON AVE SUITE B
DUBLIN OH
43017-3511
US

IV. Provider business mailing address

3982 POWELL RD SUITE 271
POWELL OH
43065-7662
US

V. Phone/Fax

Practice location:
  • Phone: 614-889-6422
  • Fax: 614-453-8863
Mailing address:
  • Phone: 614-889-6422
  • Fax: 614-453-8863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35090663
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number35090663
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: