Provider Demographics
NPI:1548498140
Name:PASCOTTO, JEREMY LOUIS (DO,)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:LOUIS
Last Name:PASCOTTO
Suffix:
Gender:M
Credentials:DO,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 LANSING ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CHARLOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48813-1696
Mailing Address - Country:US
Mailing Address - Phone:517-543-7976
Mailing Address - Fax:
Practice Address - Street 1:123 LANSING ST
Practice Address - Street 2:SUITE 2
Practice Address - City:CHARLOTTE
Practice Address - State:MI
Practice Address - Zip Code:48813-1696
Practice Address - Country:US
Practice Address - Phone:517-543-7976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-23
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101018201207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery