Healthcare Provider Details

I. General information

NPI: 1891401907
Provider Name (Legal Business Name): JACOB CLOYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2023
Last Update Date: 01/24/2023
Certification Date: 01/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 S LAPEER RD
OXFORD MI
48371-6108
US

IV. Provider business mailing address

1350 S LAPEER RD
OXFORD MI
48371-6106
US

V. Phone/Fax

Practice location:
  • Phone: 248-969-9932
  • Fax: 248-969-0840
Mailing address:
  • Phone: 248-969-9375
  • Fax: 248-969-9478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: