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General NPI Number Information
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NPI Number | 1285813154
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Entity Type | Organization
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Legal Business Name | JUNCTION CLINIC
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Dates
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Enumeration Date | 10/29/2007
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 4771 MICHIGAN AVE
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City | DETROIT
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State | MI
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Zip | 48210-3247
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Country | US
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Telephone | 313-897-2600
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Fax | 313-897-2424
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Provider Business Mailing Address
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Address Line | 4771 MICHIGAN AVE
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City | DETROIT
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State | MI
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Zip | 48210-3247
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Country | US
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Telephone | 313-897-2600
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Fax | 313-897-2424
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. JERRY UZANSKY
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Credential | D.O.
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Telephone | 313-897-2600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | GU005238
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License Number State | MI
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