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General NPI Number Information
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NPI Number | 1518195981
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Entity Type | Individual
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Provider Name | MARLA NICOLE JAHNKE MD
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Gender | Female
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Dates
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Enumeration Date | 06/24/2009
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Last Update Date | 02/14/2025
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Provider Practice Location Address
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Address Line | 3031 W GRAND BLVD STE 800
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City | DETROIT
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State | MI
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Zip | 48202-3141
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Country | US
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Telephone | 800-436-7936
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Fax |
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Provider Business Mailing Address
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Address Line | 3031 W GRAND BLVD STE 800
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City | DETROIT
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State | MI
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Zip | 48202-3141
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 4301096431
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207NP0225X
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Taxonomy Name | Pediatric Dermatology Physician
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License Number | 4301096431
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License Number State | MI
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