MEDICARE: JOHN WILLIAM HEAD JR. DO

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	2084P0800X	Psychiatry Physician	5101011560	MI

General Provider Information

NPI Number	:	1750393690
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN WILLIAM HEAD JR. DO

Provider Business Mailing Address
First Line	:	19450 ARGYLE CRES
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48203-1402
Country	:	US
Telephone Number	:	313-733-7641
Fax Number	:

Provider Business Practice Location Address
First Line	:	2925 RUSSELL ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48207-4825
Country	:	US
Telephone Number	:	313-396-5300
Fax Number	:

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

Provider Enumeration Date	:	08/12/2006
Last Update Date	:	09/06/2023

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