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General NPI Number Information
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NPI Number | 1407985385
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Entity Type | Organization
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Legal Business Name | FAMILY PHYSICIANS OF ST. JOSEPH, P.C.
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Dates
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Enumeration Date | 03/05/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2500 NILES RD SUITE 1
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City | SAINT JOSEPH
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State | MI
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Zip | 49085-3237
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Country | US
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Telephone | 269-429-5000
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Fax | 269-429-2598
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Provider Business Mailing Address
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Address Line | 2500 NILES RD SUITE 1
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City | SAINT JOSEPH
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State | MI
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Zip | 49085-3237
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Country | US
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Telephone | 269-429-5000
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Fax | 269-429-2598
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. JOHN MARTIN PROOS III
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Credential | M.D.
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Telephone | 269-429-5000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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