Individual
JACK G BELEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
20307 WEST 12 MILE ROAD, SUITE 102, SOUTHFIELD, MI 48076
(248) 356-6661
(248) 356-6619
Mailing address
20307 WEST 12 MILE ROAD, SUITE 102, SOUTHFIELD, MI 48076
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
JB042374
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1552582
—
MI
Enumeration date
07/24/2006
Last updated
07/08/2007
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