Provider Demographics
NPI:1083172878
Name:BEYDOUN, JAAFER
Entity Type:Individual
Prefix:
First Name:JAAFER
Middle Name:
Last Name:BEYDOUN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25354 EVERGREEN RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-1776
Mailing Address - Country:US
Mailing Address - Phone:248-353-2222
Mailing Address - Fax:248-262-3333
Practice Address - Street 1:25354 EVERGREEN RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-1776
Practice Address - Country:US
Practice Address - Phone:248-353-2222
Practice Address - Fax:248-262-3333
Is Sole Proprietor?:No
Enumeration Date:2019-03-11
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704282698363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner