Individual
JOSE TAD-Y EDURESE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
205 N EAST AVE, JACKSON, MI 49201-1753
(517) 788-4800
Mailing address
DEPARTMENT 272801, PO BOX 67000, DETROIT, MI 48267-2728
(517) 782-9401
(517) 784-2259
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4301032704
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101591571
—
MI
01
—
11023493
RR MEDICARE
MI
Enumeration date
05/03/2006
Last updated
01/15/2009
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