Provider Demographics
NPI:1083103600
Name:DROUILLARD, FELICIA JADE (MD)
Entity Type:Individual
Prefix:DR
First Name:FELICIA
Middle Name:JADE
Last Name:DROUILLARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:FELICIA
Other - Middle Name:JADE
Other - Last Name:FLOWERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:22201 MOROSS RD STE 370
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48236-2176
Mailing Address - Country:US
Mailing Address - Phone:313-343-4585
Mailing Address - Fax:313-343-7126
Practice Address - Street 1:22201 MOROSS RD STE 370
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48236
Practice Address - Country:US
Practice Address - Phone:313-343-4585
Practice Address - Fax:313-343-7126
Is Sole Proprietor?:No
Enumeration Date:2018-05-09
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301114489207V00000X, 390200000X
MI4301506354207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI205556884Medicaid