Doctor Name: | MR. JOEL LESTER PESTRUE |
NPI Number: | 1205027075 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | P.A. |
License Number: | |
Business Practice Address: | 5939 N Huron Rd # Us23 Oscoda, MI - 487509710 |
Business Phone Number: | 9897391441 |
Business Fax Number: | 9897396093 |
Mailing Address: | 5939 N Huron Rd # Us23, OSCODA |
State: | MI |
Postal Code: | 487509710 |
Phone Number: | 9897391441 |
Fax Number: | 9897396093 |
NPI Enumeration Date: | 08/07/2007 |
NPI Last Update Date: | 08/07/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |