Healthcare Provider Details

I. General information

NPI: 1699753871
Provider Name (Legal Business Name): JESSICA NORMILE EDWARDS D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WILLIAM CARLS DR
COMMERCE TOWNSHIP MI
48382-2201
US

IV. Provider business mailing address

4201 SAINT ANTOINE ST STE 3R
DETROIT MI
48201-2153
US

V. Phone/Fax

Practice location:
  • Phone: 248-937-4400
  • Fax:
Mailing address:
  • Phone: 313-745-3330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number5101014282
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number5101014282
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: