Individual
JET THEPSONGWAJJA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
22151 MOROSS RD, SUITE 332, DETROIT, MI 48236-2167
(313) 343-7849
(313) 343-7378
Mailing address
1251 LAKEPOINTE ST, GROSSE POINTE PARK, MI 48230-1011
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
4301099550
MI
Other
Enumeration date
09/08/2011
Last updated
09/08/2011
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