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General NPI Number Information
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NPI Number | 1598766255
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Entity Type | Individual
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Provider Name | JOSEPH GORDON EDELSON MD
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Gender | Male
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Dates
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Enumeration Date | 08/03/2005
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Last Update Date | 11/12/2024
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Provider Practice Location Address
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Address Line | 560 W MITCHELL ST STE M40
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City | PETOSKEY
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State | MI
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Zip | 49770-2278
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Country | US
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Telephone | 231-487-3637
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Fax | 231-487-6513
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Provider Business Mailing Address
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Address Line | PO BOX 844088
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City | DALLAS
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State | TX
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Zip | 75284-4088
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Country | US
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Telephone | 505-609-2258
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Fax | 505-609-2259
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 51996
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 29735
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | MD2018-0675
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License Number State | NM
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Taxonomy #4
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 4301114320
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License Number State | MI
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