=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023326667
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DMC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/16/2010
-----------------------------------------------------
Last Update Date | 09/16/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3990 JOHN R ST
-----------------------------------------------------
City | DETROIT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48201-2018
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-993-4136
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3990 JOHN R ST
-----------------------------------------------------
City | DETROIT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48201-2018
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-993-4136
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | RESIDENT
-----------------------------------------------------
Name | DR. ROOHI JEELANI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 847-414-6216
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282NW0100X
-----------------------------------------------------
Taxonomy Name | Women's Hospital
-----------------------------------------------------
License Number | 4301097252
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------