Provider Demographics
NPI:1912909540
Name:TAYEB, JUKAKU (MD)
Entity Type:Individual
Prefix:
First Name:JUKAKU
Middle Name:
Last Name:TAYEB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:45640 SCHOENHERR
Mailing Address - Street 2:SUITE B
Mailing Address - City:SHELBY
Mailing Address - State:MI
Mailing Address - Zip Code:48315-6033
Mailing Address - Country:US
Mailing Address - Phone:586-247-4300
Mailing Address - Fax:586-532-6496
Practice Address - Street 1:18001 E 10 MILE RD
Practice Address - Street 2:SUITE 1
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-3803
Practice Address - Country:US
Practice Address - Phone:586-218-5800
Practice Address - Fax:586-218-5808
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIJT406424207RN0300X
CO49014207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E95946Medicare UPIN
OH 26358-008Medicare ID - Type Unspecified