Individual
JACOB SHANE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4907 KINGSTON ST, DEARBORN HEIGHTS, MI 48125-3243
(313) 450-5573
Mailing address
4907 KINGSTON ST, DEARBORN HEIGHTS, MI 48125-3243
Taxonomy
Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
Primary
—
—
Other
Enumeration date
04/16/2026
Last updated
04/16/2026
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