Healthcare Provider Details

I. General information

NPI: 1164464202
Provider Name (Legal Business Name): JEROME MARKOWITZ DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 06/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27301 5 MILE RD
REDFORD MI
48239-3961
US

IV. Provider business mailing address

27301 FIVE MILE RD.
REDFORD MI
48239-1061
US

V. Phone/Fax

Practice location:
  • Phone: 313-535-9999
  • Fax:
Mailing address:
  • Phone: 313-535-9999
  • Fax: 313-535-9968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number5101006938
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: