Healthcare Provider Details

I. General information

NPI: 1538369426
Provider Name (Legal Business Name): ASHWANI JAISWAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2007
Last Update Date: 07/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15119 WOODWARD AVE
HIGHLAND PARK MI
48203-2907
US

IV. Provider business mailing address

15119 WOODWARD AVE
HIGHLAND PARK MI
48203-2907
US

V. Phone/Fax

Practice location:
  • Phone: 313-865-2020
  • Fax:
Mailing address:
  • Phone: 313-865-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301085804
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: