=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376999037
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JASLEEN KAUR MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/11/2016
-----------------------------------------------------
Last Update Date | 11/03/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1015 S WASHINGTON AVE
-----------------------------------------------------
City | SAGINAW
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48601-2556
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-753-5300
-----------------------------------------------------
Fax | 989-753-5099
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1015 S WASHINGTON AVE
-----------------------------------------------------
City | SAGINAW
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48601-2556
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-753-5300
-----------------------------------------------------
Fax | 989-753-5099
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RR0500X
-----------------------------------------------------
Taxonomy Name | Rheumatology Physician
-----------------------------------------------------
License Number | 4301503555
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------