Jet Thepsongwajja, M.D.

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

4301099550 Issued in MI

Practice address

22151 Moross Rd
Suite 332
Detroit, MI 48236-2167

Phone

(313) 343-7849

Fax

(313) 343-7378

NPI assigned

Sep 8, 2011

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• St. John Hospital and Medical Center

  • General Acute Care Hospital
  • Detroit, MI
  • NPI 1437439502
  NPD (past)

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

{
    "created_epoch": "1315440000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1315440000000",
    "number": "1598046153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1251 LAKEPOINTE ST",
            "city": "GROSSE POINTE PARK",
            "state": "MI",
            "postal_code": "482301011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22151 MOROSS RD",
            "address_2": "SUITE 332",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482362167",
            "telephone_number": "313-343-7849",
            "fax_number": "313-343-7378"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THEPSONGWAJJA",
        "first_name": "JET",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-09-08",
        "last_updated": "2011-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MI",
            "license": "4301099550",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• R Chase Thebault, M.D.
• Thedoshia Carter Afc#1
• Marvin John Theile, C.T.R.S.
• Brian Kevin Theisen, M.D.
• Rebecca Lauren Theisen, MD
• Theramatrix, Inc.
• Therapeutic Encounters PC
• Theraplug Inc
• Therapy & Allied Services, LLC
• Therapy Management Enterprises, Inc

• Surgery Physician in Detroit, MI
• Providers in Detroit, MI by specialty
• Surgery Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2011; 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.