Provider Demographics
NPI:1396705893
Name:MORRIS, JOHN KANDELIN (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:KANDELIN
Last Name:MORRIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4972B WEST CLARK ROAD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197
Mailing Address - Country:US
Mailing Address - Phone:734-434-3020
Mailing Address - Fax:734-434-3025
Practice Address - Street 1:4972 WEST CLARK ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197
Practice Address - Country:US
Practice Address - Phone:734-434-3020
Practice Address - Fax:734-434-3025
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301034179207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2831841Medicaid
OM80710Medicare ID - Type Unspecified
MI2831841Medicaid