Healthcare Provider Details

I. General information

NPI: 1730233966
Provider Name (Legal Business Name): JEAN-PAUL PEGERON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 E WASHINGTON ST
ANN ARBOR MI
48104-2024
US

IV. Provider business mailing address

425 E WASHINGTON ST SUITE 104-S
ANN ARBOR MI
48104-2024
US

V. Phone/Fax

Practice location:
  • Phone: 734-995-0101
  • Fax:
Mailing address:
  • Phone: 734-995-0101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberJP035054
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number4301035054
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: