Healthcare Provider Details

I. General information

NPI: 1578426839
Provider Name (Legal Business Name): JIMIA STARR GREEN PHLEBOTOMY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 12/04/2025
Certification Date: 11/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16129 W MCNICHOLS ROAD
DETROIT MI
48235-1704
US

IV. Provider business mailing address

19301 ARDMORE ST
DETROIT MI
48235-1704
US

V. Phone/Fax

Practice location:
  • Phone: 313-370-7849
  • Fax: 231-216-7861
Mailing address:
  • Phone: 313-370-7849
  • Fax: 231-216-7861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: