Healthcare Provider Details

I. General information

NPI: 1497019335
Provider Name (Legal Business Name): GURPAL K JONES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2012
Last Update Date: 08/15/2024
Certification Date: 08/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 W 13 MILE RD STE EC
ROYAL OAK MI
48073-6712
US

IV. Provider business mailing address

PO BOX 2147
FORT MYERS FL
33902-2147
US

V. Phone/Fax

Practice location:
  • Phone: 248-898-0575
  • Fax:
Mailing address:
  • Phone: 239-343-6260
  • Fax: 239-343-6259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301101512
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: