Individual
JEROME WILBORN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
28050 GRAND RIVER AVE, FARMINGTON HILLS, MI 48336-5919
(734) 464-0887
(734) 402-0254
Mailing address
36123 SCHOOLCRAFT RD, LIVONIA, MI 48150-1216
(734) 464-0887
(734) 402-0254
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4301057004
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4637100
—
MI
Enumeration date
01/25/2006
Last updated
07/29/2015
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