Individual
MR. JERRY IDICULLA CHANDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
N.P.
Contact information
Practice address
1675 KINGSWAY CT STE 1, TRENTON, MI 48183-1958
(734) 676-8530
Mailing address
1675 KINGSWAY CT STE 1, TRENTON, MI 48183-1958
(734) 676-8530
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
4704276954
MI
Other
Enumeration date
11/05/2013
Last updated
03/07/2025
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