Healthcare Provider Details

I. General information

NPI: 1538015177
Provider Name (Legal Business Name): KATHERINE MARY JEUP PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATHERINE CREAL PA

II. Dates (important events)

Enumeration Date: 03/06/2026
Last Update Date: 03/06/2026
Certification Date: 03/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

490 LINCOLN RD
GROSSE POINTE MI
48230-1609
US

IV. Provider business mailing address

490 LINCOLN RD
GROSSE POINTE MI
48230-1609
US

V. Phone/Fax

Practice location:
  • Phone: 313-515-0065
  • Fax:
Mailing address:
  • Phone: 313-515-0065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: