Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 4301111010 | MI |
NPI | 1083864565 |
---|---|
Provider Name | Kevin George Jamil |
First Address | Saint Clair Shores, MI 48080-1181 |
Second Address | Saint Clair Shores, MI 48080-1181 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2008 |
Last Update Date | 21/10/2020 |