=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770753691
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JEFFREY D JOSHOWITZ DO PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/06/2008
-----------------------------------------------------
Last Update Date | 03/06/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 39475 LEWIS DR SUITE 140
-----------------------------------------------------
City | NOVI
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48377-2981
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-489-0766
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 39475 LEWIS DR SUITE 140
-----------------------------------------------------
City | NOVI
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48377-2981
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-489-0766
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. JEFFREY D JOSHOWITZ
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 248-489-0766
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 5101010027
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------