Individual
DR. EDMUND DOROMAL JACOB
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2799 W GRAND BLVD # 417, DIVISION OF HOSPITAL MEDICINE, DETROIT, MI 48202-2608
(313) 916-8144
Mailing address
2799 W GRAND BLVD # 417, DIVISION OF HOSPITAL MEDICINE, DETROIT, MI 48202-2608
(313) 916-8144
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4301099385
MI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/23/2010
Last updated
05/29/2014
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