Individual
JACK MORDECAI PARENT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1500 E MEDICAL CENTER DR, ANN ARBOR, MI 48109-5000
(734) 936-4000
Mailing address
3621 S STATE ST, ANN ARBOR, MI 48108-1633
(734) 647-5299
Taxonomy
Speciality
Code
Description
License number
State
2084E0001X
Epilepsy Physician
Primary
4301076136
MI
2084N0400X
Neurology Physician
4301076136
MI
2084N0600X
Clinical Neurophysiology Physician
4301076136
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4222938
—
MI
Enumeration date
10/17/2006
Last updated
12/30/2024
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