Provider Demographics
NPI:1275024606
Name:AOUN, JAMAL M (DO)
Entity Type:Individual
Prefix:
First Name:JAMAL
Middle Name:M
Last Name:AOUN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5901 W VERNOR HWY
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48209-2180
Mailing Address - Country:US
Mailing Address - Phone:313-554-4357
Mailing Address - Fax:313-554-1565
Practice Address - Street 1:5901 W VERNOR HWY
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48209-2180
Practice Address - Country:US
Practice Address - Phone:313-554-4357
Practice Address - Fax:313-554-1565
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-22
Last Update Date:2021-11-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101025733207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI$$$$$$$$$Medicaid