Provider Demographics
NPI:1902862667
Name:JONES, SANDRA A (MD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:A
Last Name:JONES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 674147
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48267-4147
Mailing Address - Country:US
Mailing Address - Phone:248-354-4709
Mailing Address - Fax:248-354-4807
Practice Address - Street 1:26677 W 12 MILE RD # B6
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1514
Practice Address - Country:US
Practice Address - Phone:248-354-4709
Practice Address - Fax:248-354-4807
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301051935207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI138897OtherGREAT LAKES
MI110F336360OtherBCBSM
MI207R00000XOtherTAXONOMY
MI2790874Medicaid
MI4301051935OtherLICENSE
MIF22180OtherHAP
MI1346398971OtherGROUP NPI
MI1346398971OtherGROUP NPI
MI2790874Medicaid