Healthcare Provider Details

I. General information

NPI: 1043436132
Provider Name (Legal Business Name): JEFFREY A MORGAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 12/01/2023
Certification Date: 11/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2799 W GRAND BLVD K-14, RM 1435
DETROIT MI
48202-2608
US

IV. Provider business mailing address

2799 W GRAND BLVD K-14, RM 1435
DETROIT MI
48202-2608
US

V. Phone/Fax

Practice location:
  • Phone: 313-790-2741
  • Fax: 313-916-2687
Mailing address:
  • Phone: 313-790-2741
  • Fax: 313-916-2687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number1285
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number4301093300
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: