Healthcare Provider Details

I. General information

NPI: 1447027578
Provider Name (Legal Business Name): JILLIAN M IMAMI APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2023
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2799 W GRAND BLVD # B1451
DETROIT MI
48202-2689
US

IV. Provider business mailing address

1 FORD PL STE 3A
DETROIT MI
48202-3450
US

V. Phone/Fax

Practice location:
  • Phone: 313-916-2417
  • Fax: 313-916-8416
Mailing address:
  • Phone: 313-874-4806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704319734
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: