Healthcare Provider Details

I. General information

NPI: 1588838544
Provider Name (Legal Business Name): JEREMY DAVID HANDEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2008
Last Update Date: 10/21/2020
Certification Date: 10/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

130 TOWN CENTER DR 203
TROY MI
48084-1744
US

V. Phone/Fax

Practice location:
  • Phone: 248-898-6064
  • Fax: 248-898-5490
Mailing address:
  • Phone: 248-585-8218
  • Fax: 248-585-8266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number4301093406
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number4301093406
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: