Provider Demographics
NPI:1699718148
Name:FUENTE, JOSE E (MD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:E
Last Name:FUENTE
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 1:315 E WARWICK DR
Mailing Address - Street 2:SUITE F-2
Mailing Address - City:ALMA
Mailing Address - State:MI
Mailing Address - Zip Code:48801-1083
Mailing Address - Country:US
Mailing Address - Phone:989-463-4805
Mailing Address - Fax:989-463-4680
Practice Address - Street 1:315 E WARWICK DR
Practice Address - Street 2:SUITE F-2
Practice Address - City:ALMA
Practice Address - State:MI
Practice Address - Zip Code:48801-1083
Practice Address - Country:US
Practice Address - Phone:989-463-4805
Practice Address - Fax:989-463-4680
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301065222207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1006848OtherMCLAREN HEALTH PLAN
MI4964121Medicaid
MI0983464OtherHEALTHPLUS COMMERCIAL
MI3457591Medicaid
MI4837370Medicaid
MI1103700741OtherBCBSM
MI200000005740OtherPHP COMMERCIAL
MI1034330OtherMCLAREN HEALTH PLAN
MI4560855Medicaid
MI1102911871OtherBCBSM
MI1006847OtherMCLAREN HEALTH PLAN
MIF63596Medicare UPIN
MI4964121Medicaid
MI4837370Medicaid