Provider Demographics
NPI:1598086985
Name:MEDICAL MARIJUANNA CERTIFICATION AND FAMILY PRACTICE, PC
Entity Type:Organization
Organization Name:MEDICAL MARIJUANNA CERTIFICATION AND FAMILY PRACTICE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:ROMMEL
Authorized Official - Last Name:PIERRE-PAUL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:517-960-3634
Mailing Address - Street 1:800 CRESCENT RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49203-3865
Mailing Address - Country:US
Mailing Address - Phone:517-960-3634
Mailing Address - Fax:
Practice Address - Street 1:1302 N EATON ST
Practice Address - Street 2:
Practice Address - City:ALBION
Practice Address - State:MI
Practice Address - Zip Code:49224-1041
Practice Address - Country:US
Practice Address - Phone:517-629-3008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-19
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301090976174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty