Healthcare Provider Details

I. General information

NPI: 1275024606
Provider Name (Legal Business Name): JAMAL M AOUN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2018
Last Update Date: 11/21/2021
Certification Date: 11/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 W VERNOR HWY
DETROIT MI
48209-2180
US

IV. Provider business mailing address

5901 W VERNOR HWY
DETROIT MI
48209-2180
US

V. Phone/Fax

Practice location:
  • Phone: 313-554-4357
  • Fax: 313-554-1565
Mailing address:
  • Phone: 313-554-4357
  • Fax: 313-554-1565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101025733
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: