Provider Demographics
NPI:1053373464
Name:JOSSELSON, ALAN STUART (MD)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:STUART
Last Name:JOSSELSON
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 1:4000 WELLNESS DR
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48670-2000
Mailing Address - Country:US
Mailing Address - Phone:844-832-1956
Mailing Address - Fax:989-633-5241
Practice Address - Street 1:4100 CAMPUS RIDGE DR
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-6139
Practice Address - Country:US
Practice Address - Phone:989-488-5450
Practice Address - Fax:989-488-5455
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD017104E207RP1001X
MI4301505529207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007043110004Medicaid
PA036092EN2Medicare ID - Type UnspecifiedMEDICARE ID NUMBER
PA0007043110004Medicaid