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NPI Code Detail

MEDICARE: SALLU JABATI MD

MEDICARE: SALLU JABATI MD
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
1207L00000XAnesthesiology Physician4301510992MI
2207L00000XAnesthesiology Physician4301514834MI
3207LP2900XPain Medicine (Anesthesiology) Physician4301510992MI

General Provider Information

NPI Number : 1184185498
Entity Type Code : Individual
Provider Name (Legal Business Name) : SALLU JABATI MD
Provider Business Mailing Address
First Line : 2080 44TH ST SE STE 120
Second Line :
City : KENTWOOD
State : MI
Zip : 49508-5299
Country : US
Telephone Number : 616-500-0977
Fax Number :
Provider Business Practice Location Address
First Line : 2080 44TH ST SE STE 120
Second Line :
City : KENTWOOD
State : MI
Zip : 49508-5299
Country : US
Telephone Number : 616-500-0977
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/28/2019
Last Update Date : 06/09/2025

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