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General NPI Number Information
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NPI Number | 1790531374
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Entity Type | Individual
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Provider Name | JAMAAL EDWARD CANN
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Gender | Male
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Dates
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Enumeration Date | 04/25/2024
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Last Update Date | 04/25/2024
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Provider Practice Location Address
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Address Line | 4203 18TH ST
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City | DETROIT
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State | MI
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Zip | 48208-2515
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Country | US
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Telephone | 586-339-7110
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Fax |
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Provider Business Mailing Address
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Address Line | 3026 MARLBOROUGH ST
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City | DETROIT
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State | MI
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Zip | 48215-2536
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Country | US
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Telephone | 586-339-7110
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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 | 172A00000X
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Taxonomy Name | Driver
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License Number |
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License Number State | MI
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