Healthcare Provider Details

I. General information

NPI: 1922012897
Provider Name (Legal Business Name): OLAN JAREUNPOON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9740 CONANT ST
HAMTRAMCK MI
48212-3307
US

IV. Provider business mailing address

2280 RED MAPLE DR
TROY MI
48098-2248
US

V. Phone/Fax

Practice location:
  • Phone: 313-556-9900
  • Fax: 313-556-9911
Mailing address:
  • Phone: 248-879-5799
  • Fax: 248-879-4854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number34342
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: