Individual
LISA ROSELIN JACOB
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
6777 W MAPLE RD, WEST BLOOMFIELD, MI 48322
(313) 205-8581
Mailing address
6199 WINCLIFF DR, WEST BLOOMFIELD, MI 48322-4800
(610) 247-1086
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
036138036
IL
207L00000X
Anesthesiology Physician
Primary
4301109137
MI
Other
Enumeration date
04/29/2010
Last updated
07/05/2018
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