Healthcare Provider Details

I. General information

NPI: 1306047717
Provider Name (Legal Business Name): JANARDHAN RAO JAGINI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 11/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 BEAUBIEN ST CHILDREN'S HOSPITAL, 3RD FLOOR
DETROIT MI
48201-2119
US

IV. Provider business mailing address

29120 FRANKLIN RD
SOUTHFIELD MI
48034-1105
US

V. Phone/Fax

Practice location:
  • Phone: 313-745-9048
  • Fax: 313-993-3879
Mailing address:
  • Phone: 248-355-3100
  • Fax: 348-354-8378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License Number4301085240
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: