MEDICARE: DR. JESSICA EDWARDS 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	207PE0004X	Emergency Medical Services (Emergency Medicine) Physician	5101014282	MI
2	207P00000X	Emergency Medicine Physician	5101014282	MI

General Provider Information

NPI Number	:	1699753871
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESSICA EDWARDS D.O.

Provider Business Mailing Address
First Line	:	4201 SAINT ANTOINE ST STE 3R
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48201-2153
Country	:	US
Telephone Number	:	313-745-3330
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 WILLIAM CARLS DR
Second Line	:
City	:	COMMERCE TOWNSHIP
State	:	MI
Zip	:	48382-2201
Country	:	US
Telephone Number	:	248-937-4400
Fax Number	:

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

Provider Enumeration Date	:	01/06/2006
Last Update Date	:	01/15/2026

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