Healthcare Provider Details

I. General information

NPI: 1528988987
Provider Name (Legal Business Name): JALEN MIMS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6900 E 10 MILE RD
CENTER LINE MI
48015-1168
US

IV. Provider business mailing address

2399 E WALTON BLVD
AUBURN HILLS MI
48326-1955
US

V. Phone/Fax

Practice location:
  • Phone: 586-501-3070
  • Fax:
Mailing address:
  • Phone: 248-475-6300
  • Fax: 248-475-6730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: