Provider Demographics
NPI:1538734785
Name:MERSIER BEY, JASMINE I (DO)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:I
Last Name:MERSIER BEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JASMINE
Other - Middle Name:I
Other - Last Name:RUDOLPH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1855 N LAKE DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-5382
Mailing Address - Country:US
Mailing Address - Phone:248-763-1129
Mailing Address - Fax:
Practice Address - Street 1:DETROIT MEDICAL CENTER
Practice Address - Street 2:4201 ST. ANTOINE
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-4820
Practice Address - Country:US
Practice Address - Phone:313-993-2530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-20
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL036171918207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program