NPIMap

Organization Active NPI

Jan Medical Group PLLC

  • Family Medicine Physician
  • Clinton Township, MI
National Provider Identifier
1043694979
Registry record updated Sep 19, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
4301092978 Issued in MI
Legal business name
JAN MEDICAL GROUP PLLC
Practice address
43361 Commons Dr
Clinton Township, MI 48038-1109
Phone
(586) 690-7994
Fax
(586) 569-2589
NPI assigned
Jul 9, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Fadi I Ibrahim, M.D.
Title
Member
Phone
(586) 690-7994

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207Q00000X 4301092978 MI Primary

Addresses

Primary practice location

43361 Commons Dr
Clinton Township, MI 48038-1109

Mailing address

43361 Commons Dr
Clinton Township, MI 48038-1109
Phone (586) 690-7994

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1436400000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1474243200000",
    "number": "1043694979",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "43361 COMMONS DR",
            "city": "CLINTON TOWNSHIP",
            "state": "MI",
            "postal_code": "480381109",
            "telephone_number": "586-690-7994",
            "fax_number": "586-569-2589"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "43361 COMMONS DR",
            "city": "CLINTON TOWNSHIP",
            "state": "MI",
            "postal_code": "480381109",
            "telephone_number": "586-690-7994",
            "fax_number": "586-569-2589"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JAN MEDICAL GROUP PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-09",
        "last_updated": "2016-09-19",
        "status": "A",
        "authorized_official_last_name": "IBRAHIM",
        "authorized_official_first_name": "FADI",
        "authorized_official_middle_name": "I",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "586-690-7994",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301092978",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clinton Township, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.