Healthcare Provider Details

I. General information

NPI: 1275774531
Provider Name (Legal Business Name): INTEGRATED GERIATRIC SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2009
Last Update Date: 03/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3080 FLEMING LAKE DR
ANN ARBOR MI
48105-8000
US

IV. Provider business mailing address

2211 JACKSON AVE
ANN ARBOR MI
48103-3919
US

V. Phone/Fax

Practice location:
  • Phone: 734-812-4219
  • Fax: 734-327-6180
Mailing address:
  • Phone: 734-812-4219
  • Fax: 734-327-6180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberJW057004
License Number StateMI

VIII. Authorized Official

Name: DR. JEROME WILBORN JR.
Title or Position: OWNER /SOLE MEMBER /PRACTITIONER
Credential: M.D.
Phone: 734-812-4219