Basic Information
| Provider Information | |||||||||
| NPI: | 1497718142 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AKERVALL | ||||||||
| FirstName: | JAN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5333 MCAULEY DR | ||||||||
| Address2: | RM 2017 | ||||||||
| City: | YPSILANTI | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481971096 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7344343200 | ||||||||
| FaxNumber: | 7344343209 | ||||||||
| Practice Location | |||||||||
| Address1: | 28300 ORCHARD LAKE RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | FARMINGTON HILLS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483343704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2487374030 | ||||||||
| FaxNumber: | 2487370636 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2006 | ||||||||
| LastUpdateDate: | 03/30/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | 4301075498 | MI | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | 4454674 | 05 | MI | MEDICAID | CI0239 | 01 | MI | RAILROAD MEDICARE | OTHER |