MEDICARE: DR. JEROME SITNER D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	JS005168	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	0P01030	OTHER	MI	MEDICARE GROUP NUMBER
5	P0103003	OTHER	MI	MEDICARE INDIVIDUAL #S

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	381886254	OTHER	MI	COMMERICAL NUMBERS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	1164492500	OTHER	MI	NPI INDIVIDUAL
6	0858218024	OTHER	MI	BCBS NUMBERS
7	1285813154	OTHER	MI	NPI # GROUP

General Provider Information

NPI Number	:	1164492500
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEROME SITNER D.O.

Provider Business Mailing Address
First Line	:	4771 MICHIGAN AVE
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48210-3247
Country	:	US
Telephone Number	:	313-897-2600
Fax Number	:	313-897-2424

Provider Business Practice Location Address
First Line	:	4771 MICHIGAN AVE
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48210-3247
Country	:	US
Telephone Number	:	313-897-2600
Fax Number	:	313-897-2424

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2006
Last Update Date	:	10/29/2007

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Directions to “ DR. JEROME SITNER D.O.” Practice Location

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