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Individual

JOEL BENJAMIN DINVERNO

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
11755 E MICHIGAN AVE, GRASS LAKE, MI 49240-9219
(517) 522-6100
(517) 522-4715
Mailing address
11755 E MICHIGAN AVE, GRASS LAKE, MI 49240-9219
(517) 522-6100
(517) 522-4715

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
4301073676
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
104717265
MI
01
3503810581
BCBS
MI
Enumeration date
06/06/2006
Last updated
01/26/2009
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