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General NPI Number Information
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NPI Number | 1306848353
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Entity Type | Individual
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Provider Name | JOHN JERIUS MD
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Gender | Male
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Dates
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Enumeration Date | 08/10/2005
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Last Update Date | 06/01/2010
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Provider Practice Location Address
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Address Line | 27150 RYAN RD
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City | WARREN
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State | MI
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Zip | 48092-5124
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Country | US
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Telephone | 586-693-3821
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1048
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City | WARREN
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State | MI
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Zip | 48090-1048
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Country | US
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Telephone |
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Fax |
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 4301080979
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License Number State | MI
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