Basic Information
| Provider Information | |||||||||
| NPI: | 1407304975 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DOBSON | ||||||||
| FirstName: | JORDAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15930 19 MILE ROAD. SUITE 150 | ||||||||
| Address2: | |||||||||
| City: | CLINTON TWP. | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5864640175 | ||||||||
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| Address1: | 15930 19 MILE RD STE 150 | ||||||||
| Address2: | |||||||||
| City: | CLINTON TOWNSHIP | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480381155 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5864640175 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2016 | ||||||||
| LastUpdateDate: | 09/14/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 247200000X | MI | Y | Technologists, Technicians & Other Technical Service Providers | Technician, Other |
No ID Information.