Organization
INTEGRATED GERIATRIC SERVICES PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEROME WILBORN JR. M.D. (OWNER /SOLE MEMBER /PRACTITIONER)
(734) 812-4219
Entity
Organization
Contact information
Practice address
3080 FLEMING LAKE DR, ANN ARBOR, MI 48105-8000
(734) 812-4219
(734) 327-6180
Mailing address
2211 JACKSON AVE, ANN ARBOR, MI 48103-3919
(734) 812-4219
(734) 327-6180
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
JW057004
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1750351516
INDIVIDUAL NPI TYPE 1
MI
05
—
4637100-10
—
MI
Enumeration date
03/17/2009
Last updated
03/17/2009
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