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General NPI Number Information
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NPI Number | 1275774531
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Entity Type | Organization
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Legal Business Name | INTEGRATED GERIATRIC SERVICES PLLC
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Dates
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Enumeration Date | 03/17/2009
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Last Update Date | 03/17/2009
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Provider Practice Location Address
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Address Line | 3080 FLEMING LAKE DR
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City | ANN ARBOR
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State | MI
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Zip | 48105-8000
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Country | US
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Telephone | 734-812-4219
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Fax | 734-327-6180
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Provider Business Mailing Address
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Address Line | 2211 JACKSON AVE
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City | ANN ARBOR
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State | MI
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Zip | 48103-3919
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Country | US
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Telephone | 734-812-4219
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Fax | 734-327-6180
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Authorized Official
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Title or Position | OWNER /SOLE MEMBER /PRACTITIONER
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Name | DR. JEROME WILBORN JR.
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Credential | M.D.
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Telephone | 734-812-4219
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | JW057004
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License Number State | MI
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