Healthcare Provider Details

I. General information

NPI: 1285954834
Provider Name (Legal Business Name): OLAN JAREUNPOON, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2010
Last Update Date: 06/07/2010
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: 248-879-5779
  • Fax: 248-879-4854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number208600000X
License Number StateMI

VIII. Authorized Official

Name: OLAN JAREUNPOON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 248-879-5799