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NPI Code Detail

MEDICARE: DR. JACK CONSIDINE MD

MEDICARE: DR. JACK CONSIDINE 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
1390200000XStudent in an Organized Health Care Education/Training ProgramMI

General Provider Information

NPI Number : 1700733326
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JACK CONSIDINE MD
Provider Business Mailing Address
First Line : 402 CARTER DR
Second Line :
City : TROY
State : MI
Zip : 48098-4657
Country : US
Telephone Number : 248-828-5235
Fax Number :
Provider Business Practice Location Address
First Line : 2799 W GRAND BLVD
Second Line :
City : DETROIT
State : MI
Zip : 48202-2689
Country : US
Telephone Number : 313-916-2600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/12/2026
Last Update Date : 03/12/2026

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