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General NPI Number Information
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NPI Number | 1477097590
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Entity Type | Individual
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Provider Name | SAMARTH JADAV
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Gender | Male
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Dates
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Enumeration Date | 12/08/2016
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Last Update Date | 12/08/2016
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Provider Practice Location Address
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Address Line | 20755 GREENFIELD RD STE 602
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City | SOUTHFIELD
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State | MI
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Zip | 48075-5409
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Country | US
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Telephone | 248-443-8088
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Fax | 248-443-8099
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Provider Business Mailing Address
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Address Line | 2652 BEACON HILL DR APT 207
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City | AUBURN HILLS
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State | MI
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Zip | 48326-3729
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Country | US
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Telephone | 248-325-4710
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5501017604
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License Number State | MI
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