Healthcare Provider Details

I. General information

NPI: 1750078630
Provider Name (Legal Business Name): HUSSEIN JABRE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2023
Last Update Date: 07/11/2024
Certification Date: 07/11/2024
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

PO BOX 111
BLOOMFIELD HILLS MI
48303-0111
US

V. Phone/Fax

Practice location:
  • Phone: 313-871-3751
  • Fax:
Mailing address:
  • Phone: 407-451-5211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number5151016361
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: