Provider Demographics
NPI:1376502096
Name:PARIS, JASON CHRISTOPHER (MD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:CHRISTOPHER
Last Name:PARIS
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 1:16801 NEWBURGH RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-1606
Mailing Address - Country:US
Mailing Address - Phone:734-591-6660
Mailing Address - Fax:734-447-8514
Practice Address - Street 1:16801 NEWBURGH RD
Practice Address - Street 2:SUITE 106
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-1606
Practice Address - Country:US
Practice Address - Phone:734-591-6660
Practice Address - Fax:734-744-8514
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-21
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301084904207R00000X, 207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0308246562OtherBC PIN
MII14054Medicare UPIN
MIP13340002Medicare PIN
MIP13350002Medicare PIN