Provider Demographics
NPI:1710940242
Name:THE, JEFF Y (DO)
Entity Type:Individual
Prefix:DR
First Name:JEFF
Middle Name:Y
Last Name:THE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:990 W ANN ARBOR TRL
Mailing Address - Street 2:SUITE 202
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-6204
Mailing Address - Country:US
Mailing Address - Phone:734-455-8497
Mailing Address - Fax:734-455-7907
Practice Address - Street 1:990 W ANN ARBOR TRL
Practice Address - Street 2:SUITE 202
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-6204
Practice Address - Country:US
Practice Address - Phone:734-455-8497
Practice Address - Fax:734-455-7907
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIJT011068207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1158207454OtherBCBS
MI103654OtherCARE CHOICES/PREFERRED CH
MI4530838Medicaid
MI4530838Medicaid
MIF42098Medicare UPIN