Provider Demographics
NPI:1285954834
Name:OLAN JAREUNPOON, M.D., P.C.
Entity type:Organization
Organization Name:OLAN JAREUNPOON, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OLAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JAREUNPOON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-879-5799
Mailing Address - Street 1:2280 RED MAPLE DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48098-2248
Mailing Address - Country:US
Mailing Address - Phone:248-879-5779
Mailing Address - Fax:248-879-4854
Practice Address - Street 1:9740 CONANT ST
Practice Address - Street 2:
Practice Address - City:HAMTRAMCK
Practice Address - State:MI
Practice Address - Zip Code:48212-3307
Practice Address - Country:US
Practice Address - Phone:313-556-9900
Practice Address - Fax:313-556-9911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-06
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI208600000X261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1420298 TYPE 10Medicaid
MI0630292Medicare PIN
MIA75214Medicare UPIN