Provider Demographics
NPI:1427503226
Name:SWEET, JAMIE (LMT)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:SWEET
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1537 N LEROY ST
Mailing Address - Street 2:STE D
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-2795
Mailing Address - Country:US
Mailing Address - Phone:810-522-4540
Mailing Address - Fax:
Practice Address - Street 1:1537 N LEROY ST
Practice Address - Street 2:STE D
Practice Address - City:FENTON
Practice Address - State:MI
Practice Address - Zip Code:48430-2795
Practice Address - Country:US
Practice Address - Phone:810-522-4540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-22
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501004632173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine