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Individual

DR. PALLAVI JASTI

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
M.D

Contact information

Practice address
15855 19 MILE RD, CLINTON TWP, MI 48038-3504
(586) 263-2506
Mailing address
4646 JOHN R ST, 11-HMO, DETROIT, MI 48201-1916
(313) 576-1000
(313) 576-1824

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
4301082244
MI
207RH0003X
Hematology & Oncology Physician
Primary
4301082244
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0930080
BCBSM
MI
01
4301082244
STATE LICENSE
MI
01
5315027169
CONTROLLED DRUG LICENSE
MI
Enumeration date
05/05/2008
Last updated
03/22/2024
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