MEDICARE: JOSEPH STERRITT

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
1	390200000X	Student in an Organized Health Care Education/Training Program	5302042603	MI

General Provider Information

NPI Number	:	1700310679
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH STERRITT

Provider Business Mailing Address
First Line	:	2875 RIVER RD
Second Line	:
City	:	TWIN LAKE
State	:	MI
Zip	:	49457-8806
Country	:	US
Telephone Number	:	231-744-5008
Fax Number	:

Provider Business Practice Location Address
First Line	:	2875 RIVER RD
Second Line	:
City	:	TWIN LAKE
State	:	MI
Zip	:	49457-8806
Country	:	US
Telephone Number	:	231-744-5008
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/17/2017
Last Update Date	:	04/17/2017

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Directions to “ JOSEPH STERRITT ” Practice Location

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