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General NPI Number Information
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NPI Number | 1285035030
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Entity Type | Individual
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Provider Name | JAYANTHI CHANDRASEKARAN
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Gender | Female
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Dates
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Enumeration Date | 09/11/2014
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Last Update Date | 06/11/2018
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Provider Practice Location Address
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Address Line | 28411 NORTHWESTERN HWY STE 1050
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City | SOUTHFIELD
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State | MI
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Zip | 48034
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Country | US
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Telephone | 855-442-2552
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Fax | 247-354-4807
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Provider Business Mailing Address
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Address Line | 28411 NORTHWESTERN HWY STE 1050
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City | SOUTHFIELD
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State | MI
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Zip | 48034-5529
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Country | US
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Telephone | 855-442-2552
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Fax | 247-354-4807
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 57.024105
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 4301111660
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License Number State | MI
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