Individual
JENNIFER B MITSUYA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
3535 W 13 MILE RD STE 707, ROYAL OAK, MI 48073
(248) 551-0487
(248) 551-3696
Mailing address
26901 BEAUMONT BOULEVARD, SOUTHFIELD, MI 48033
(947) 522-1858
(248) 350-4123
Taxonomy
Speciality
Code
Description
License number
State
2080P0206X
Pediatric Gastroenterology Physician
Primary
5101019846
MI
Other
Enumeration date
04/02/2012
Last updated
10/22/2020
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