Individual
JACLYN RANDEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
5333 MCAULEY DR RM 5011, YPSILANTI, MI 48197-1003
(734) 622-5016
(734) 622-5017
Mailing address
24 FRANK LLOYD WRIGHT DR LBBY J2000, ANN ARBOR, MI 48105-9484
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
4301054205
MI
207QA0401X
Addiction Medicine (Family Medicine) Physician
Primary
4301054205
MI
Other
Enumeration date
01/23/2006
Last updated
06/13/2019
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