Individual
DR. JEFFREY EDWIN MIDDELDORF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
5700 E 11 MILE ROAD, SUITE C, WARREN, MI 48089
(586) 558-4482
(586) 558-8923
Mailing address
888 WEST BIG BEAVER ROAD, SUITE 480, TROY, MI 48084-4764
(248) 797-8324
(248) 816-5173
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
2301003007
MI
208100000X
Physical Medicine & Rehabilitation Physician
2238841
NY
208100000X
Physical Medicine & Rehabilitation Physician
Primary
5101012371
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2555002114BX33
BC/BS
—
05
—
3742088
—
MI
Enumeration date
08/22/2006
Last updated
12/10/2013
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