Healthcare Provider Details

I. General information

NPI: 1144717505
Provider Name (Legal Business Name): JASBIR SINGH D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2018
Last Update Date: 02/08/2025
Certification Date: 02/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 E MAIN ST STE 202
NORTHVILLE MI
48167-1689
US

IV. Provider business mailing address

489 5TH AVE FL 3
NEW YORK NY
10017-6145
US

V. Phone/Fax

Practice location:
  • Phone: 248-622-0596
  • Fax:
Mailing address:
  • Phone: 248-622-0596
  • 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 StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number316392
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number5101025274
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: