Organization
PORT HURON INTERNAL MEDICINE ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN I JARAD M.D. (PRESIDENT)
(810) 987-1000
Entity
Organization
Contact information
Practice address
2540 16TH ST, PORT HURON, MI 48060-6405
(810) 987-1000
(810) 982-1810
Mailing address
2540 16TH ST, PORT HURON, MI 48060-6405
(810) 987-1000
(810) 982-1810
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
4301066771
MI
207R00000X
Internal Medicine Physician
4301076169
MI
207R00000X
Internal Medicine Physician
4301095172
MI
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
4301061093
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0G41221
BCBSM
MI
01
—
34108
HEALTH PLAN OF MICHIGAN
MI
01
—
DG3605
RAILROAD MEDICARE PIN
MI
Enumeration date
09/06/2007
Last updated
02/06/2015
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