Provider Demographics
NPI:1962843946
Name:NATHAN, JAY KIRAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:KIRAN
Last Name:NATHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:24 FRANK LLOYD WRIGHT DR STE J2000
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-9484
Mailing Address - Country:US
Mailing Address - Phone:734-712-4500
Mailing Address - Fax:
Practice Address - Street 1:19000 ST JOE'S PARKWAY
Practice Address - Street 2:SUITE 420
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152
Practice Address - Country:US
Practice Address - Phone:734-712-4500
Practice Address - Fax:734-712-4475
Is Sole Proprietor?:No
Enumeration Date:2013-07-08
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301102528174400000X, 207T00000X
IN01085782A207T00000X
CAA167468207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No174400000XOther Service ProvidersSpecialist