Individual
JACEY ANE LEPAGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
22101 MOROSS RD, DETROIT, MI 48236-2148
(313) 343-4000
Mailing address
22101 MOROSS RD, DETROIT, MI 48236-2148
Taxonomy
Speciality
Code
Description
License number
State
2086S0127X
Trauma Surgery Physician
Primary
01086554A
IN
390200000X
Student in an Organized Health Care Education/Training Program
4301107377
MI
Other
Enumeration date
06/18/2015
Last updated
10/12/2021
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