Individual
BRIDGETTE L JERRELS
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
D.P.M.
Contact information
Practice address
15488 WILDEMERE ST, DETROIT, MI 48238-1438
(313) 863-5783
Mailing address
PO BOX 20045, FERNDALE, MI 48220-0045
(313) 863-5783
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
5901001553
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2828087
—
MI
01
—
485-82-5187-0
BCBSM
—
Enumeration date
09/09/2005
Last updated
07/08/2007
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