Individual
JEFFREY LOUIS PROVIZER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
32255 NORTHWESTERN HWY STE 130, FARMINGTON HILLS, MI 48334
(248) 723-5880
(248) 723-5889
Mailing address
29992 NORTHWESTERN HWY STE C, FARMINGTON HILLS, MI 48334-3292
(248) 851-1430
(248) 851-5182
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
5101013058
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1316931405
—
MI
Enumeration date
09/06/2005
Last updated
12/11/2018
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