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NPI Code Detail

MEDICARE: JEFFREY A LONDON MD

MEDICARE: JEFFREY A LONDON 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
12084P0804XChild & Adolescent Psychiatry Physician4301040691MI

General Provider Information

NPI Number : 1285645929
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEFFREY A LONDON MD
Provider Business Mailing Address
First Line : 2075 W BIG BEAVER RD STE 520
Second Line :
City : TROY
State : MI
Zip : 48084-3442
Country : US
Telephone Number : 248-646-6659
Fax Number : 248-642-8645
Provider Business Practice Location Address
First Line : 2075 W BIG BEAVER RD STE 520
Second Line :
City : TROY
State : MI
Zip : 48084-3442
Country : US
Telephone Number : 248-646-6659
Fax Number : 248-642-8645
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/10/2006
Last Update Date : 03/05/2020

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