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NPI Code Detail

MEDICARE: JP ADVANCED SERVICE, CORP.

MEDICARE: JP ADVANCED SERVICE, CORP.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1053584094
Entity Type Code : Organization
Provider Name (Legal Business Name) : JP ADVANCED SERVICE, CORP.
Provider Business Mailing Address
First Line : 31705 PLYMOUTH RD
Second Line :
City : LIVONIA
State : MI
Zip : 48150-1905
Country : US
Telephone Number : 248-579-7177
Fax Number :
Provider Business Practice Location Address
First Line : 31705 PLYMOUTH RD
Second Line :
City : LIVONIA
State : MI
Zip : 48150-1905
Country : US
Telephone Number : 734-266-7840
Fax Number : 734-266-7841
Authorized Official
Title or Position : PRESIDENT
Name : MR. JORGE A AZAR
Credential :
Telephone Number : 734-266-7840
Provider Enumeration Date : 04/10/2008
Last Update Date : 08/13/2008

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Directions to “JP ADVANCED SERVICE, CORP. ” Practice Location

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