Individual
DR. MICHELLE RENEE JUPIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.P.M.
Contact information
Practice address
641 W 9 MILE RD, FERNDALE, MI 48220-1779
(248) 548-7363
(248) 548-5304
Mailing address
641 W 9 MILE RD, FERNDALE, MI 48220-1779
(248) 548-7363
(248) 548-5304
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
5901002054
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
38-2469733
TAX ID FOR PRIMARY LOCATI
MI
05
—
4617312
—
MI
01
—
4856310140
BLUE CROSS BLUE SHIELD
MI
Enumeration date
07/07/2005
Last updated
05/15/2008
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