Provider Demographics
NPI:1467226779
Name:THE PURERX DBA PROMAIDS LLC
Entity Type:Organization
Organization Name:THE PURERX DBA PROMAIDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MIRNA
Authorized Official - Middle Name:
Authorized Official - Last Name:JADAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-890-8940
Mailing Address - Street 1:2354 ERICKSON DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48085-6718
Mailing Address - Country:US
Mailing Address - Phone:248-890-8940
Mailing Address - Fax:
Practice Address - Street 1:5130 COOLIDGE HWY
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-1001
Practice Address - Country:US
Practice Address - Phone:248-288-9500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-08
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202D00000XAllopathic & Osteopathic PhysiciansIntegrative Medicine