Provider Demographics
NPI:1134335359
Name:APPEL, JERRY AVRUM (DO)
Entity type:Individual
Prefix:DR
First Name:JERRY
Middle Name:AVRUM
Last Name:APPEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 SOUTH HILL BLVD
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48304-1135
Mailing Address - Country:US
Mailing Address - Phone:248-853-5399
Mailing Address - Fax:248-853-5996
Practice Address - Street 1:1720 SOUTH HILL BLVD
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48304-1135
Practice Address - Country:US
Practice Address - Phone:248-853-5399
Practice Address - Fax:248-853-5996
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101006075207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2820150Medicaid
MI2820150Medicaid