Provider Demographics
NPI:1982605275
Name:PARCELLS, JEFFREY HUBBARD (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:HUBBARD
Last Name:PARCELLS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24911 LITTLE MACK AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-3200
Mailing Address - Country:US
Mailing Address - Phone:586-777-2050
Mailing Address - Fax:586-777-2189
Practice Address - Street 1:24911 LITTLE MACK AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-3200
Practice Address - Country:US
Practice Address - Phone:586-777-2050
Practice Address - Fax:586-777-2189
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301049455207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2907609Medicaid
MI700E012740OtherBCBS GROUP NUMBER
MI700E012740OtherBCBS GROUP NUMBER
MID83128Medicare UPIN
MIN40170122Medicare PIN
MI0N40170Medicare PIN