Provider Demographics
NPI:1770747594
Name:JAYAKAR, SHAUN M (MD)
Entity type:Individual
Prefix:DR
First Name:SHAUN
Middle Name:M
Last Name:JAYAKAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1356 BRYS DR
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-1017
Mailing Address - Country:US
Mailing Address - Phone:313-402-6580
Mailing Address - Fax:
Practice Address - Street 1:31150 HOOVER
Practice Address - Street 2:SUITE B
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093
Practice Address - Country:US
Practice Address - Phone:586-983-3666
Practice Address - Fax:586-983-3776
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301086680207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine