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General NPI Number Information
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NPI Number | 1396368643
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Entity Type | Individual
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Provider Name | MIRNA JADAN MD
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Gender | Female
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Dates
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Enumeration Date | 05/21/2020
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Last Update Date | 06/24/2025
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Provider Practice Location Address
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Address Line | 2370 E STADIUM BLVD # 2049
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City | ANN ARBOR
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State | MI
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Zip | 48104-4811
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Country | US
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Telephone | 650-503-9990
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Fax |
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Provider Business Mailing Address
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Address Line | 2354 ERICKSON DR
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City | TROY
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State | MI
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Zip | 48085-6718
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Country | US
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Telephone | 248-890-8940
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 4301509024
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License Number State | MI
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