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NPI Code Detail

MEDICARE: PHOEBEE JEAN

MEDICARE: PHOEBEE JEAN
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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1588515423
Entity Type Code : Individual
Provider Name (Legal Business Name) : PHOEBEE JEAN
Provider Business Mailing Address
First Line : 17320 W 12 MILE RD STE 101
Second Line :
City : SOUTHFIELD
State : MI
Zip : 48076-2102
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 17320 W 12 MILE RD STE 101
Second Line :
City : SOUTHFIELD
State : MI
Zip : 48076-2102
Country : US
Telephone Number : 248-727-3456
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/06/2026
Last Update Date : 02/06/2026

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Directions to “ PHOEBEE JEAN ” Practice Location

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