Healthcare Provider Details

I. General information

NPI: 1699349951
Provider Name (Legal Business Name): JUDE ALRAHMAN JARAKI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2021
Last Update Date: 05/19/2021
Certification Date: 04/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 SAINT ANTOINE ST # 9C
DETROIT MI
48201-2153
US

IV. Provider business mailing address

8020 NW 167TH TER
MIAMI LAKES FL
33016-3426
US

V. Phone/Fax

Practice location:
  • Phone: 313-577-5009
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: