Provider Demographics
NPI:1497718142
Name:AKERVALL, JAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JAN
Middle Name:
Last Name:AKERVALL
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 1:5333 MCAULEY DR
Mailing Address - Street 2:RM 2017
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-1096
Mailing Address - Country:US
Mailing Address - Phone:734-434-3200
Mailing Address - Fax:734-434-3209
Practice Address - Street 1:28300 ORCHARD LAKE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-3704
Practice Address - Country:US
Practice Address - Phone:248-737-4030
Practice Address - Fax:248-737-0636
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301075498207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4454674Medicaid
MICI0239OtherRAILROAD MEDICARE
MICI0239OtherRAILROAD MEDICARE
MI4454674Medicaid