Healthcare Provider Details

I. General information

NPI: 1972533032
Provider Name (Legal Business Name): JEFFREY G OBRON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 12/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6079 W MAPLE RD SUITE 110
WEST BLOOMFIELD MI
48322-2283
US

IV. Provider business mailing address

6079 W MAPLE RD SUITE 110
WEST BLOOMFIELD MI
48322-2283
US

V. Phone/Fax

Practice location:
  • Phone: 248-535-3221
  • Fax: 248-325-9613
Mailing address:
  • Phone: 248-535-3221
  • Fax: 248-325-9613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberJO043992
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: