Provider Demographics
NPI:1215974753
Name:COUMARBATCH, JIRA G (MD)
Entity type:Individual
Prefix:
First Name:JIRA
Middle Name:G
Last Name:COUMARBATCH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 47068
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-4768
Mailing Address - Country:US
Mailing Address - Phone:248-443-6911
Mailing Address - Fax:248-443-6594
Practice Address - Street 1:23077 GREENFIELD RD STE 489
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-3740
Practice Address - Country:US
Practice Address - Phone:248-395-6312
Practice Address - Fax:248-395-6314
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2022-07-21
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Provider Licenses
StateLicense IDTaxonomies
MI4301077874207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine