Doctor Name: | FILEMON JOSE INOCENCIO |
NPI Number: | 1194965335 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | 4301041260 |
Business Practice Address: | 4047 Lake Chapin Rd Berrien Springs, MI - 491039654 |
Business Phone Number: | 2698153052 |
Business Fax Number: | 2698153052 |
Mailing Address: | 4047 Lake Chapin Rd, BERRIEN SPRINGS |
State: | MI |
Postal Code: | 491039654 |
Phone Number: | 2698153052 |
Fax Number: | 2698153052 |
NPI Enumeration Date: | 02/28/2009 |
NPI Last Update Date: | 02/28/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 207QA0505X |
License Number: | 4301041260 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | Family Medicine |
Taxonomy Specialization: | Adult Medicine |
Taxonomy Definition: |