Healthcare Provider Details

I. General information

NPI: 1396368643
Provider Name (Legal Business Name): MIRNA JADAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2020
Last Update Date: 03/07/2026
Certification Date: 03/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2370 E STADIUM BLVD # 2049
ANN ARBOR MI
48104-4811
US

IV. Provider business mailing address

1440 N EDGEWOOD ST FL 4
ARLINGTON VA
22201-7037
US

V. Phone/Fax

Practice location:
  • Phone: 650-503-9990
  • Fax:
Mailing address:
  • Phone: 202-335-0428
  • Fax: 202-985-6906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301509024
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: