Organization
JOEL L PELAVIN MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS TRACY L HALPIN C O A (BILLER)
(586) 296-7770
Entity
Organization
Contact information
Practice address
29750 HARPER AVE, SAINT CLAIR SHORES, MI 48082-2607
(586) 296-7770
(586) 296-9617
Mailing address
29750 HARPER AVE, SAINT CLAIR SHORES, MI 48082-2607
(586) 296-7770
(586) 296-9617
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
JP042865
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
JP042865
MEDICAL LICENSE NUMBER
MI
Enumeration date
02/28/2007
Last updated
04/20/2008
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