Provider Demographics
NPI:1952575219
Name:F M JARA MD PC
Entity Type:Organization
Organization Name:F M JARA MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:M
Authorized Official - Last Name:JARA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-732-8621
Mailing Address - Street 1:4568 BEECHER RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-2615
Mailing Address - Country:US
Mailing Address - Phone:810-762-8621
Mailing Address - Fax:810-732-8676
Practice Address - Street 1:4568 BEECHER RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-2615
Practice Address - Country:US
Practice Address - Phone:810-762-8621
Practice Address - Fax:810-732-8676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIFJ037807208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4447517Medicaid
MI0N60690Medicare PIN
MI4447517Medicaid