Individual
JAISY JACOB
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4100 JOHN R ST, DETROIT, MI 48201-2013
(313) 576-9900
Mailing address
4100 JOHN R ST, DETROIT, MI 48201-2013
(313) 576-9900
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
4301107800
MI
2085R0202X
Diagnostic Radiology Physician
Primary
4301107800
MI
Other
Enumeration date
03/30/2011
Last updated
05/13/2022
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