MEDICARE: DR. MICHAEL FRANK JERMOV DDS

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
1	122300000X	Dentist	2901013472	MI

General Provider Information

NPI Number	:	1326074717
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL FRANK JERMOV DDS

Provider Business Mailing Address
First Line	:	13756 MERRIE MEADOW LN
Second Line	:
City	:	SOUTH LYON
State	:	MI
Zip	:	48178
Country	:	US
Telephone Number	:	248-486-2656
Fax Number	:

Provider Business Practice Location Address
First Line	:	1444 INKSTER RD
Second Line	:
City	:	INKSTER
State	:	MI
Zip	:	48141-1829
Country	:	US
Telephone Number	:	313-565-5980
Fax Number	:	313-565-5097

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2006
Last Update Date	:	07/08/2007

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