Provider Demographics
NPI:1962516047
Name:SPRAGUE, JANET L (DO)
Entity type:Individual
Prefix:DR
First Name:JANET
Middle Name:L
Last Name:SPRAGUE
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 68
Mailing Address - Street 2:
Mailing Address - City:MULLIKEN
Mailing Address - State:MI
Mailing Address - Zip Code:48861-0068
Mailing Address - Country:US
Mailing Address - Phone:517-449-8705
Mailing Address - Fax:517-878-7185
Practice Address - Street 1:7686 TUPPER LAKE RD
Practice Address - Street 2:
Practice Address - City:SUNFIELD
Practice Address - State:MI
Practice Address - Zip Code:48890-9740
Practice Address - Country:US
Practice Address - Phone:517-449-8705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJS012810207Q00000X
MI5101012810207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI383639554OtherTAX ID
MIJS012810OtherLICENSE NUMBER
MI4427238Medicaid
MIG80627Medicare UPIN