Healthcare Provider Details

I. General information

NPI: 1023820982
Provider Name (Legal Business Name): DANA JAALOUK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2025
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3031 W GRAND BLVD STE 600
DETROIT MI
48202-3014
US

IV. Provider business mailing address

1851 N MCKENZIE ST
FOLEY AL
36535-4700
US

V. Phone/Fax

Practice location:
  • Phone: 313-871-3751
  • Fax:
Mailing address:
  • Phone: 251-424-1232
  • Fax: 251-424-1954

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: