JACLYN RANDEL (NPI# 1386624591) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1386624591 |
| Entity Type | Individual |
| Full Name | JACLYN RANDEL |
| Credential | MD |
| Practice Address |
5333 Mcauley Dr Rm 5011 Ypsilanti MI 48197-1003 |
| Mailing Address |
24 Frank Lloyd Wright Dr Lbby J2000 Ann Arbor MI 48105-9484 |
| Practice Telephone | 7346225016 |
| Practice Fax Number | 7346225017 |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2019-06-13 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207Q00000X | Family Medicine | 4301054205 | MI | Allopathic & Osteopathic Physicians |
| Y | 207QA0401X |
Family Medicine Specialization: Addiction Medicine |
4301054205 | MI | Allopathic & Osteopathic Physicians |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 2001 S Merriman Rd, Suite 100, Westland, MI 481865539 | 7347271000 | |
| 4200 Whitehall Dr Ste 250, Ann Arbor, MI 48105 | 7346225016 | 7346225017 |
| Street Address |
5333 MCAULEY DR RM 5011 |
| City | YPSILANTI |
| State | MI |
| Zip Code | 48197-1003 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023540853 | Brendan Sullivan | Student in an Organized Health Care Education/Training Program | 5333 Mcauley Dr Rm 5011, Ypsilanti, MI 48197-1003 | 2017-03-30 |
| 1356793954 | Iha Health Services Corporation | Internal Medicine | 5333 Mcauley Dr Rm 5011, Ypsilanti, MI 48197-1003 | 2016-07-07 |
| 1790076537 | Michael Francis | Physician Assistant | 5333 Mcauley Dr Rm 5011, Ypsilanti, MI 48197-1003 | 2011-04-27 |
| 1669590352 | Mark A Weiner | Internal Medicine | 5333 Mcauley Dr Rm 5011, Ypsilanti, MI 48197-1003 | 2007-03-27 |
| 1487744512 | Sarah Cookinham | Internal Medicine | 5333 Mcauley Dr Rm 5011, Ypsilanti, MI 48197-1003 | 2006-10-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700423092 | Devika Dibya Choudhuri | Counselor | 135 Porter West Circle Drive, Ypsilanti, MI 48197 | 2019-12-05 |
| 1770128837 | Brian Lee Shue | Registered Nurse | 6277 Maplehurst Dr, Ypsilanti, MI 48197 | 2019-11-13 |
| 1639721566 | Darlene E Bellers | 845 W. Circle Dr, Suite 160, Ypsilanti, MI 48197 | 2019-07-11 | |
| 1073165874 | Eastern Michigan University | Dietitian, Registered | Suite 160 Rackham, Ypsilanti, MI 48197 | 2019-07-11 |
| 1447815469 | Rainbow Rehabilitation Centers, Inc. | Community Based Residential Treatment Facility, Mental Illness | 6200 Textile Rd, Ypsilanti, MI 48197 | 2019-05-06 |
| 1417416298 | Justin Brewer | Student in an Organized Health Care Education/Training Program | 5333 Mcauley Drive Suite 2115, Ypsilanti, MI 48197 | 2019-03-19 |
| 1124519780 | Great Lakes Mindfulness LLC | Community/Behavioral Health | 4007 Carpenter Rd # 280, Ypsilanti, MI 48197 | 2018-05-19 |
| 1841799715 | Bedside Angel's Home Care, LLC | Home Health | 2032 S. Congress Street, Ypsilanti, MI 48197 | 2018-02-06 |
| 1891211777 | Brandon James Kukal | Specialist/Technologist | 799 N Hewitt, Ypslinati, MI 48197 | 2017-08-22 |
| 1669908737 | Michael Bekkerman | Student in an Organized Health Care Education/Training Program | 5303 Elliot Drive, Cancer Center, Ypsilanti, MI 48197 | 2017-05-10 |
| Find all providers in zip 48197 | ||||
| Taxonomy Code | 207QA0401X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Specialization | Addiction Medicine |
| A family medicine physician who specializes in the diagnosis and treatment of addictions. |
| Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A Certification of Added Qualifications (CAQ) was, but is no longer issued by the American Osteopathic Board of Family Physicians. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598703621 | Carl Woodrow Christensen | Family Medicine | 4870 W Clark Rd Ste 201, Ypsilanti, MI 48197-1104 | 2006-06-02 |
| 1164830048 | Carl Christensen Md Pllc | Family Medicine | 2370 Leforge Rd, Ypsilanti, MI 48198-9638 | 2014-07-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740836444 | White Lake Urgent Care | Family Medicine | 9178 Highland Rd Ste 1a, White Lake, MI 48386-4619 | 2019-08-18 |
| 1669665154 | Daniel A. Schwarz | Family Medicine | 18444 W 10 Mile Rd, Suite 102, Southfield, MI 48075-2653 | 2007-08-20 |
| 1134335359 | Jerry Avrum Appel | Family Medicine | 1720 South Hill Blvd, Bloomfield Township, MI 48304-1135 | 2007-05-15 |
| 1417099417 | Bio-med Behavioral Healthcare, Inc. | Family Medicine | 31581 Gratiot Ave, Roseville, MI 48066-4528 | 2007-02-13 |
| 1457469330 | Eric N. Coffman | Family Medicine | 27550 Joy Rd, Livonia, MI 48150-4145 | 2006-08-29 |
| 1265498059 | Mark Allen Menestrina | Family Medicine | 12851 E Grand River, Brighton Hospital, Brighton, MI 48116-8596 | 2006-04-21 |
| 1790745966 | Douglas Lawrence Marsh | Family Medicine | 18590 Allen Rd, Melvindale, MI 48122-1516 | 2006-03-23 |
| 1952377566 | Bruce Henry Baker | Family Medicine | 3210 Eagle Run Dr, Suite 200, Grand Rapids, MI 49525 | 2006-02-23 |
| 1689275026 | Lindsey Ruth Mitchell | Family Medicine | 28477 Hoover Rd, Warren, MI 48093-5400 | 2020-11-03 |
| 1568084333 | Great Lakes Addiction Recovery Services Pllc | Family Medicine | 142 E Maumee St, Adrian, MI 49221-2735 | 2020-05-14 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.