Basic Information
| Provider Information | |||||||||
| NPI: | 1760408827 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JOLIE | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | N | ||||||||
| NamePrefix: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9 INDUSTRIAL RD | ||||||||
| Address2: | STE 5 | ||||||||
| City: | MILFORD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 017573736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5085285932 | ||||||||
| FaxNumber: | 5085412420 | ||||||||
| Practice Location | |||||||||
| Address1: | 14 PROSPECT ST | ||||||||
| Address2: | |||||||||
| City: | MILFORD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 017573003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5084731190 | ||||||||
| FaxNumber: | 5084825416 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2006 | ||||||||
| LastUpdateDate: | 02/18/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 02/18/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | 203921 | MA | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 203921 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0112631 | 05 | MA | MEDICAID |