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1316931405
JEFFREY LOUIS PROVIZER
FARMINGTON HILLS, MI
NPI
1316931405
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
207Q00000X Family Medicine
(Licence: MI 5101013058)
Enumeration Date
2005-09-06
Last Update Date
2018-12-11
Business Address
JEFFREY LOUIS PROVIZER DO
32255 NORTHWESTERN HWY STE 130
FARMINGTON HILLS, MI 48334
Phone number: 248-723-5880
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Mailing Address
JEFFREY LOUIS PROVIZER DO
29992 NORTHWESTERN HWY STE C
FARMINGTON HILLS, MI 48334-3292
Phone number: 248-851-1430
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