Individual
MR. JEROME EDWIN MONTGOMERY JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
35425 W MICHIGAN AVE, WAYNE, MI 48184-9800
(734) 725-8719
Mailing address
35425 W MICHIGAN AVE, WAYNE, MI 48184-9800
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
6802089266
MI
Other
Enumeration date
07/05/2022
Last updated
07/05/2022
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