Provider Demographics
NPI:1164464202
Name:MARKOWITZ, JEROME (DO)
Entity type:Individual
Prefix:DR
First Name:JEROME
Middle Name:
Last Name:MARKOWITZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27301 FIVE MILE RD.
Mailing Address - Street 2:
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48239-1061
Mailing Address - Country:US
Mailing Address - Phone:313-535-9999
Mailing Address - Fax:313-535-9968
Practice Address - Street 1:27301 5 MILE RD
Practice Address - Street 2:
Practice Address - City:REDFORD
Practice Address - State:MI
Practice Address - Zip Code:48239-3961
Practice Address - Country:US
Practice Address - Phone:313-535-9999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101006938207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4111910Medicaid
MI4111910Medicaid