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General NPI Number Information
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NPI Number | 1710915905
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Entity Type | Individual
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Provider Name | JASON EDWARD POSTULA M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/28/2006
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Last Update Date | 06/18/2025
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Provider Practice Location Address
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Address Line | 12660 TEN MILE RD # 2A
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City | SOUTH LYON
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State | MI
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Zip | 48178-9141
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Country | US
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Telephone | 810-895-4070
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Fax | 833-972-1137
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Provider Business Mailing Address
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Address Line | 12660 TEN MILE RD # 2A
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City | SOUTH LYON
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State | MI
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Zip | 48178-9141
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Country | US
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Telephone | 810-895-4070
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Fax | 833-972-1137
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 4301076568
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License Number State | MI
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