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General NPI Number Information
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NPI Number | 1558852871
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Entity Type | Individual
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Provider Name | JANA DBAIBOU M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/22/2018
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Last Update Date | 06/19/2024
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Provider Practice Location Address
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Address Line | 4201 ST. ANTOINE ST. SUITE 2E
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City | DETROIT
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State | MI
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Zip | 48201
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Country | US
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Telephone | 313-745-7888
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 9156
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City | MORGANTOWN
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State | WV
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Zip | 26506-9156
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Country | US
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Telephone | 313-745-7888
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 30542
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License Number State | WV
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