Provider Demographics
NPI:1114301942
Name:MATHEW, JINU PUTHENPARAMPIL (MD)
Entity type:Individual
Prefix:
First Name:JINU
Middle Name:PUTHENPARAMPIL
Last Name:MATHEW
Suffix:
Gender:
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3175 W PROFESSIONAL DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706
Mailing Address - Country:US
Mailing Address - Phone:989-667-3400
Mailing Address - Fax:989-667-2114
Practice Address - Street 1:3175 W PROFESSIONAL DR
Practice Address - Street 2:SUITE 1
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706
Practice Address - Country:US
Practice Address - Phone:989-667-3400
Practice Address - Fax:989-667-2114
Is Sole Proprietor?:No
Enumeration Date:2015-07-10
Last Update Date:2025-03-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301107217207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine