Provider Demographics
NPI:1518525641
Name:PAPACONSTANDINOU, JASON ALEXANDER (MD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:ALEXANDER
Last Name:PAPACONSTANDINOU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3031 W GRAND BLVD STE 450
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-3026
Mailing Address - Country:US
Mailing Address - Phone:313-346-5235
Mailing Address - Fax:313-879-6960
Practice Address - Street 1:3031 W GRAND BLVD STE 450
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-3026
Practice Address - Country:US
Practice Address - Phone:313-346-5235
Practice Address - Fax:313-879-6960
Is Sole Proprietor?:No
Enumeration Date:2019-06-04
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI43510456942084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry