MEDICARE: J C CLINIC

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	2084P0800X	Psychiatry Physician	4301079383	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	H79731	OTHER	HAP HMO
3	136855	OTHER	CARE CHOICES

General Provider Information

NPI Number	:	1265498125
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	J C CLINIC

Provider Business Mailing Address
First Line	:	2035 HOGBACK RD
Second Line	:	SUITE 209
City	:	ANN ARBOR
State	:	MI
Zip	:	48105-9732
Country	:	US
Telephone Number	:	734-794-0112
Fax Number	:	734-794-0112

Provider Business Practice Location Address
First Line	:	2035 HOGBACK RD
Second Line	:	SUITE 209
City	:	ANN ARBOR
State	:	MI
Zip	:	48105-9732
Country	:	US
Telephone Number	:	734-794-0112
Fax Number	:	734-794-0112

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JUN CAO
Credential	:	M.D.
Telephone Number	:	734-794-0112

Provider Enumeration Date	:	04/20/2006
Last Update Date	:	08/22/2020

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Directions to “J C CLINIC ” Practice Location

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