Healthcare Provider Details

I. General information

NPI: 1619895646
Provider Name (Legal Business Name): MARYAM J JUNDI
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29600 NORTHWESTERN HWY
SOUTHFIELD MI
48034-1016
US

IV. Provider business mailing address

7542 GREENWAY LN
WEST BLOOMFIELD MI
48324-4796
US

V. Phone/Fax

Practice location:
  • Phone: 248-838-3390
  • Fax:
Mailing address:
  • Phone: 248-937-0167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberJ530585031404
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: