JAISY JACOB (NPI# 1639468614) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639468614 |
| Entity Type | Individual |
| Full Name | JAISY JACOB |
| Practice Address |
4100 John R St Detroit MI 48201-2013 |
| Practice Telephone | 3135769900 |
| Mailing Telephone | 3135769900 |
| Enumeration Date | 2011-03-30 |
| Last Update Date | 2020-05-15 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2085B0100X |
Radiology Specialization: Body Imaging |
4301107800 | MI | Allopathic & Osteopathic Physicians |
| N | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
4301107800 | MI | Allopathic & Osteopathic Physicians |
| N | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 3601 W 13 Mile Rd, Royal Oak, MI 48073 | 2488986031 |
| Street Address |
4100 JOHN R ST |
| City | DETROIT |
| State | MI |
| Zip Code | 48201-2013 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518966316 | Cynthia Hilda Marsack | Nurse Practitioner | 4100 John R St, Karmanos Cancer Ctr Midlevels, Detroit, MI 48201-2013 | 2005-07-14 |
| 1467062950 | Amy Josephine Skotzke | Nurse Practitioner | 4100 John R St, Detroit, MI 48201-2013 | 2020-08-09 |
| 1700421294 | Nicole Gonzalez | Nurse Practitioner | 4100 John R St, Detroit, MI 48201-2013 | 2019-11-08 |
| 1881237485 | Joseph Charles Ellul | Internal Medicine | 4100 John R St, Detroit, MI 48201-2013 | 2019-10-26 |
| 1841840113 | Thoracic Surgical Services, PC | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 4100 John R St, Detroit, MI 48201-2013 | 2019-09-18 |
| 1568016244 | Ellen Wong Dillard | Nurse Practitioner | 4100 John R St, Detroit, MI 48201-2013 | 2019-07-30 |
| 1700340924 | Rita J Dibiase | Nurse Practitioner | 4100 John R St, Detroit, MI 48201-2013 | 2019-01-23 |
| 1336634468 | Linsday Anne Cleveland | Nurse Practitioner | 4100 John R St, Detroit, MI 48201-2013 | 2018-07-01 |
| 1407347214 | Diana Rudnev | Nurse Practitioner | 4100 John R St, Detroit, MI 48201-2013 | 2018-05-29 |
| 1912408915 | Yaukpala Ina Gofan | Nurse Practitioner | 4100 John R St, Detroit, MI 48201-2013 | 2018-02-24 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659989838 | Saima Sharif | Student in an Organized Health Care Education/Training Program | 4201 St Antoine St 9c-uhc Detroit Education & Research, Detroit, MI 48201 | 2020-07-14 |
| 1609494384 | Praveen Kumar Boddu | Student in an Organized Health Care Education/Training Program | 3901,beaubien, Ste 3t72, Children's Hospital, Detroit, MI 48201 | 2020-07-09 |
| 1730707720 | Amr Hassan Abdelghaffar Omar | Pediatrics | 3901 Beaubien St Room 3t72, Children's Hospital of Michigan, Detroit, MI 48201 | 2020-07-07 |
| 1700400694 | Hassan Imtiaz | Student in an Organized Health Care Education/Training Program | 4201 St. Antoine 8c-uhc, Detroit Medical Center, Detroit, MI 48201 | 2020-06-05 |
| 1598389074 | Alaa Awad Elkarim | Student in an Organized Health Care Education/Training Program | 3901 Beaubien St. 3t72, Detroit, MI 48201 | 2020-06-01 |
| 1891319299 | Jeongyeon Hwang | Student in an Organized Health Care Education/Training Program | 4201 St Antoine Street University Health Center - 8c, Detroit, MI 48201 | 2020-06-01 |
| 1477176576 | Jaudat Fatima Masood | Student in an Organized Health Care Education/Training Program | 4201 St Antoine Street, University Health Center - 8c, Detroit, MI 48201 | 2020-05-22 |
| 1205459419 | Amit Kumar Dahiya | Student in an Organized Health Care Education/Training Program | 11201 St. Antoine, Room 2e Uhc, Detroit, MI 48201 | 2020-05-21 |
| 1851914188 | Asra Nausheen Shaik | Student in an Organized Health Care Education/Training Program | 4201 St. Antoine St, Room 2e-uhc, Detroit, MI 48201 | 2020-05-21 |
| 1568085751 | Camille Olechowski | Student in an Organized Health Care Education/Training Program | 3901 Chrysler Dr. Detroit Medical Center, Room 5-a 538.1, Detroit, MI 48201 | 2020-05-21 |
| Find all providers in zip 48201 | ||||
| Taxonomy Code | 2085B0100X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Body Imaging |
| A Radiology doctor of Osteopathy that specializes in Body Imaging. |
| Notes: Source: National Uniform Claim Committee, 2008 [7/1/2008: definiton added, source added] Additional Resources: The American Osteopathic Board of Radiology no longer offers a certificate in this specialty. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407143068 | Shawn Brandenburg | Radiology | 2799 W Grand Blvd, Detroit, MI 48202-2608 | 2011-07-05 |
| 1073825634 | John R Hanna | Radiology | 2799 W Grand Blvd, Detroit, MI 48202-2608 | 2010-07-11 |
| 1982731261 | Subhash Chander | Radiology | 3990 John R St, Detroit, MI 48201-2018 | 2007-02-27 |
| 1417905050 | Brenda Weingarten | Radiology | 2799 W Grand Blvd, Detroit, MI 48202 | 2006-05-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316284243 | Paula Kristine Maas | Radiology | 1904 Goldeneye Dr, Holland, MI 49424-6080 | 2013-01-11 |
| 1952548778 | Anthony P Kozma | Radiology | 26861 W River Rd, Grosse Ile, MI 48138-2135 | 2009-01-15 |
| 1053459529 | Sharon Cohen Siegel | Radiology | 264 Lakewood Dr, Bloomfield Hills, MI 48304-3531 | 2007-02-04 |
| 1306948989 | Donald Roger Klein | Radiology | 1299 Porters Ln, Bloomfield Hills, MI 48302-0941 | 2006-09-02 |
| 1316994213 | Anthony A Bennett M D P C | Radiology | 29777 Telegraph Rd, Southfield, MI 48034-7625 | 2006-05-27 |
| 1891747614 | Michigan State University | Radiology | 804 Service Rd # D100, East Lansing, MI 48824-7015 | 2006-05-17 |
| 1831192640 | Won B Chae | Radiology | 29829 Telegraph Rd, Ste L103, Southfield, MI 48034-1376 | 2005-05-24 |
| 1609499847 | Ron Guron | Radiology | 36475 Five Mile Rd, Livonia, MI 48154-1971 | 2020-05-21 |
| 1568020741 | Cristian Chagas | Radiology | 18101 Oakwood Blvd, Dearborn, MI 48124-4089 | 2019-06-03 |
| 1588923148 | Saginaw Valley Medical Imaging | Radiology | 4200 Fashion Square Blvd, Suite 1, Saginaw, MI 48603-1375 | 2012-05-16 |
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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.