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NPI Code Detail

MEDICARE: MR. JOEL LESTER PESTRUE P.A.

MEDICARE: MR. JOEL LESTER PESTRUE P.A.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician Assistant

General Provider Information

NPI Number : 1205027075
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JOEL LESTER PESTRUE P.A.
Provider Business Mailing Address
First Line : 5939 N HURON RD
Second Line :
City : OSCODA
State : MI
Zip : 48750-9710
Country : US
Telephone Number : 989-739-1441
Fax Number : 989-739-6093
Provider Business Practice Location Address
First Line : 5939 N HURON RD
Second Line :
City : OSCODA
State : MI
Zip : 48750-9710
Country : US
Telephone Number : 989-739-1441
Fax Number : 989-739-6093
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/07/2007
Last Update Date : 04/06/2021

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Directions to “ MR. JOEL LESTER PESTRUE P.A.” Practice Location

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