Healthcare Provider Details

I. General information

NPI: 1932277746
Provider Name (Legal Business Name): JULES E. CONSTANTINOU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 09/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HENRY FORD HEALTH SYSTEM 3031 WEST GRAND BLVD.
DETROIT MI
48202
US

IV. Provider business mailing address

HENRY FORD HEALTH SYSTEM 3031 WEST GRAND BLVD.
DETROIT MI
48202
US

V. Phone/Fax

Practice location:
  • Phone: 313-916-2454
  • Fax:
Mailing address:
  • Phone: 313-916-2454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301077010
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number4301077010
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: