Provider Demographics
NPI:1235159815
Name:CATRAMBONE, JEFFREY EUGENE (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:EUGENE
Last Name:CATRAMBONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 BEAUBIEN SECOND FLOOR
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201
Mailing Address - Country:US
Mailing Address - Phone:313-833-4490
Mailing Address - Fax:313-993-8744
Practice Address - Street 1:3901 BEAUBIEN SECOND FLOOR
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201
Practice Address - Country:US
Practice Address - Phone:313-833-4490
Practice Address - Fax:313-993-8744
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07466300207T00000X
MI4301095381207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ9036806Medicaid
H78010Medicare UPIN
NJ066958Medicare ID - Type Unspecified