Healthcare Provider Details

I. General information

NPI: 1790680890
Provider Name (Legal Business Name): JAWUAN BOUNDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12815 W 7 MILE RD
DETROIT MI
48235-1304
US

IV. Provider business mailing address

28576 GLASGOW ST
SOUTHFIELD MI
48076-7304
US

V. Phone/Fax

Practice location:
  • Phone: 248-910-6884
  • Fax:
Mailing address:
  • Phone: 248-810-1003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: