Provider Demographics
NPI:1184078792
Name:JON JEN PLLC
Entity type:Organization
Organization Name:JON JEN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:KATTOO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-933-9500
Mailing Address - Street 1:6704 COUNTRY CLUB LN
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-3972
Mailing Address - Country:US
Mailing Address - Phone:248-933-9500
Mailing Address - Fax:
Practice Address - Street 1:6704 COUNTRY CLUB LN
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-3972
Practice Address - Country:US
Practice Address - Phone:248-933-9500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-20
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301062208207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Single Specialty