Individual
FARAD KEITH PRUITT
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
205 N EAST AVE, JACKSON, MI 49201-1753
(517) 841-1328
(517) 841-1320
Mailing address
PO BOX 67000, DEPARTMENT 272801, DETROIT, MI 48267-2728
(517) 841-6913
(517) 841-6917
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4301074892
MI
Other
Enumeration date
05/17/2006
Last updated
07/08/2007
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