Provider Demographics
NPI:1396703526
Name:DY, JOSE T (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:T
Last Name:DY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 1239
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48099-1239
Mailing Address - Country:US
Mailing Address - Phone:248-824-6600
Mailing Address - Fax:248-324-1477
Practice Address - Street 1:3515 MASSILLON RD
Practice Address - Street 2:SUITE 250
Practice Address - City:UNIONTOWN
Practice Address - State:OH
Practice Address - Zip Code:44685-7854
Practice Address - Country:US
Practice Address - Phone:330-896-5651
Practice Address - Fax:330-896-5685
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2013-04-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH35037126207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0260097Medicaid
OH0260097Medicaid
B77437Medicare UPIN