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NPI Code Detail

MEDICARE: JAY A HAROLDS MD

MEDICARE:   JAY A HAROLDS  MD
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
12085R0202XDiagnostic Radiology Physician12562OK
22085R0202XDiagnostic Radiology Physician4301097371MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1720081649
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAY A HAROLDS MD
Provider Business Mailing Address
First Line : 3264 N EVERGREEN DR NE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49525-9746
Country : US
Telephone Number : 616-363-7339
Fax Number : 616-361-5828
Provider Business Practice Location Address
First Line : 3264 N EVERGREEN DR NE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49525-9746
Country : US
Telephone Number : 616-363-7339
Fax Number : 616-361-5828
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/24/2005
Last Update Date : 10/06/2010

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