Jerry Idiculla Chandy N.P.

NPI 1023447695 - Nurse Practitioner - 363LA2200X

NPI Details
NPI 1023447695
Gender Male
Enumeration Date 11/05/2013
Last Updated 11/05/2013
Entity Type Individual
Active Over 3 years ago
Practice Location
1675 KINGSWAY CT STE 1
TRENTON MI, 48183-1958, US
Phone (734) 676-8530
Fax
Business Location
1675 KINGSWAY CT STE 1
TRENTON MI, 48183-1958, US
Phone (734) 676-8530
Fax
Toxanomy
Taxonomy Code 363LA2200X
License State Michigan
License Number 4704276954
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According to our database, Mr. Jerry Idiculla Chandy N.P. NPI is 1023447695, taxonomy code is 363LA2200X and license number is 4704276954, license state is located at Michigan. Jerry Idiculla Chandy N.P. physically located at 1675 Kingsway Ct Ste 1, Trenton MI, 48183-1958. NPI Number Jerry Idiculla Chandy N.P. has the Individual type.

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1023447695 NPI number is provided on an as is basis without warranty of any kind. 1023447695 is maintained by the National Plan & Provider Enumeration System. The contents of Jerry Idiculla Chandy N.P. are for informational purposes only.