1285954834 NPI number — OLAN JAREUNPOON, M.D., P.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285954834 NPI number — OLAN JAREUNPOON, M.D., P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OLAN JAREUNPOON, M.D., P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285954834
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/07/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2280 RED MAPLE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TROY
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48098-2248
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-879-5779
Provider Business Mailing Address Fax Number:
248-879-4854

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9740 CONANT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAMTRAMCK
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48212-3307
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-556-9900
Provider Business Practice Location Address Fax Number:
313-556-9911
Provider Enumeration Date:
06/06/2010

Additional Information

Authorized Official

Authorized Official Last Name:
JAREUNPOON
Authorized Official First Name:
OLAN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
248-879-5799

Provider Taxonomy Codes

  • Taxonomy code: 261QM2500X , with the licence number:  208600000X , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1420298 TYPE 10 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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