Healthcare Provider Details

I. General information

NPI: 1992649750
Provider Name (Legal Business Name): EAST DETROIT PRIMARY CARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6455 GRATIOT AVE STE B
DETROIT MI
48207-1953
US

IV. Provider business mailing address

6455 GRATIOT AVE STE B
DETROIT MI
48207-1953
US

V. Phone/Fax

Practice location:
  • Phone: 313-789-1800
  • Fax:
Mailing address:
  • Phone: 313-789-1800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KETURAH JEFFRIES
Title or Position: PHYSICIAN/OWNER
Credential: MD
Phone: 313-789-1800