Provider Demographics
NPI:1992788251
Name:ASPEN MEDICAL PARTNERS LLC
Entity type:Organization
Organization Name:ASPEN MEDICAL PARTNERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:STANLEY
Authorized Official - Last Name:PEYTON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:734-856-6360
Mailing Address - Street 1:7581 SECOR RD
Mailing Address - Street 2:
Mailing Address - City:LAMBERTVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48144-9624
Mailing Address - Country:US
Mailing Address - Phone:734-856-6360
Mailing Address - Fax:734-856-6364
Practice Address - Street 1:7581 SECOR RD
Practice Address - Street 2:
Practice Address - City:LAMBERTVILLE
Practice Address - State:MI
Practice Address - Zip Code:48144-9624
Practice Address - Country:US
Practice Address - Phone:734-856-6360
Practice Address - Fax:734-856-6364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-21
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101010477207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2535920Medicaid
MI800E810810OtherBCBSM
MI0P04960Medicare PIN
MI0P07650Medicare PIN