MARYANN PRAKASH JACOB (NPI# 1649665670) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1649665670 |
| Entity Type | Individual |
| Full Name | MARYANN PRAKASH JACOB |
| Credential | M.D. |
| Practice Address |
2799 W Grand Blvd Detroit MI 48202-2608 |
| Mailing Address |
85 Winthrop Ave Yonkers NY 10710-3620 |
| Practice Telephone | 3138745378 |
| Mailing Telephone | 9143385455 |
| Enumeration Date | 2015-04-06 |
| Last Update Date | 2015-04-06 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208D00000X | General Practice | 94698 | ZZ | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356375315 | Maryann Kuruvilla Jacob | Psychiatry & Neurology | 1256 Briarcliff Rd Ne Rm 321, Atlanta, GA 30306-2636 | 2006-07-10 |
| Street Address |
2799 W GRAND BLVD |
| City | DETROIT |
| State | MI |
| Zip Code | 48202-2608 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235132069 | Donna Prince | Radiology | 2799 W Grand Blvd, Detroit, MI 48202-2608 | 2005-05-24 |
| 1790386704 | Alexandria L Blevins | Nurse Practitioner | 2799 W Grand Blvd, Detroit, MI 48202-2608 | 2020-11-05 |
| 1255932430 | Amy Katlyn Carion | 2799 W Grand Blvd, Detroit, MI 48202-2608 | 2020-11-04 | |
| 1871194415 | Alexandria Denise Roberts | Physical Therapist | 2799 W Grand Blvd, Detroit, MI 48202-2689 | 2020-11-02 |
| 1174121420 | John Charles Sanno | Nurse Practitioner | 2799 W Grand Blvd, Detroit, MI 48202-2689 | 2020-10-09 |
| 1932706991 | Fallon J Awe | Nurse Practitioner | 2799 W Grand Blvd, Detroit, MI 48202-2608 | 2020-10-02 |
| 1922615145 | Chelsea Elizabeth Owen | Nurse Anesthetist, Certified Registered | 2799 W Grand Blvd, Detroit, MI 48202-2608 | 2020-10-01 |
| 1275130395 | Zana Latkovac | Nurse Practitioner | 2799 W Grand Blvd, Detroit, MI 48202-2608 | 2020-10-01 |
| 1487260030 | Jessica Lee Moret | Nurse Practitioner | 2799 W Grand Blvd, Detroit, MI 48202-2608 | 2020-09-18 |
| 1932713237 | Lucas Costa Santos | Anesthesiology | 2799 W Grand Blvd, Detroit, MI 48202-2608 | 2020-09-03 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710584602 | Andrea Irene Martin | Audiologist | 2799 E Grand Blvd, Detroit, MI 48202 | 2020-10-05 |
| 1174132583 | Odei Alayyas | Student in an Organized Health Care Education/Training Program | 2799 W. Grand Boulevard Henry Ford Hospital, Medical Ed, Detroit, MI 48202 | 2020-07-31 |
| 1912529801 | Aroob Nabil Nimer Sweidan | Student in an Organized Health Care Education/Training Program | 2799 West Grand Boulvard, Department of Internal Meidicine, Cfp 1, Detroit, MI 48202 | 2020-05-13 |
| 1306485636 | Katie Burlen-davis | Registered Nurse | 9045 Woodward Ave, Detroit, MI 48202 | 2020-01-03 |
| 1407401250 | Santhalakshmi Angappan | Student in an Organized Health Care Education/Training Program | Henry Ford Hospital Medical Education Department, 2799 W. Grand Boulevard, Detroit, MI 48202 | 2019-08-08 |
| 1851945687 | Walter Mitini Etoh | Nurse Practitioner | Henry Ford Hospital I1 Observation, 2799 W. Grand Blvd, Detroit, MI 48202 | 2019-07-30 |
| 1467913756 | Andrew Michael Schock | Emergency Medicine | Ceci Murrell-harvey, Henry Ford Hospital, 2799 W. Grand. Blvd, Cfp 046, Detroit, MI 48202 | 2019-03-28 |
| 1700363892 | Zaid Al-saheli | Student in an Organized Health Care Education/Training Program | 2799 W. Grand Blvdl, Cfp 046, Hope Peck, Detroit, MI 48202 | 2018-07-23 |
| 1932690096 | Yusuf Naser Alalwan | Student in an Organized Health Care Education/Training Program | 2799 W. Grand Blvd. Henry Ford Hospital - Gme Office, Detroit, MI 48202 | 2018-05-24 |
| 1568952729 | Kelvin Sellers | Massage Therapist | 832 Seward, Detriot, MI 48202 | 2018-05-14 |
| Find all providers in zip 48202 | ||||
| Taxonomy Code | 208D00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | General Practice |
| Definition to come... |
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|---|---|---|---|---|
| 1215422555 | The Natural Momma Me Initiative | General Practice | 11000 W Mcnichols Rd Ste 212, Detroit, MI 48221-2389 | 2018-06-28 |
| 1629515770 | Pinnacle Medical Group | General Practice | 535 Griswold St Ste 212, Detroit, MI 48226-3604 | 2017-01-27 |
| 1104170281 | Bryant Medical Staffing Services Group Inc. | General Practice | 1753 E 7 Mile Rd, Detroit, MI 48203-2159 | 2012-10-29 |
| 1316290281 | Higher Standard Therapeutics Rehab PC | General Practice | 14402 Gratiot Ave., Detroit, MI 48205-2307 | 2012-10-17 |
| 1578845400 | Hands Helping You LLC | General Practice | 17181 Pontchartrain Blvd, Detroit, MI 48203-1774 | 2011-09-16 |
| 1487944385 | Better Days Adult Activity Center LLC | General Practice | 17251 Huntington Rd, Detroit, MI 48219-3520 | 2011-04-12 |
| 1669788121 | Az Medical Services Management LLC | General Practice | 7405 Puritan St, Detroit, MI 48238-1207 | 2010-08-23 |
| 1871720342 | Vernor Mc Inc | General Practice | 7649 W Vernor Hwy, Detroit, MI 48209-1513 | 2009-06-11 |
| 1003070723 | Mark Beard | General Practice | 5700 W Vernor Hwy, Detroit, MI 48209 | 2008-07-11 |
| 1184892754 | David Jonnalagadda Md PC | General Practice | 6001 W Outer Dr Ste 320, Detroit, MI 48235-2626 | 2008-02-15 |
| Find all providers in DETROIT | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.