Most Relevant Information
Provider Data
| NPI Number: | 1003512955 |
| Provider Name: | JERRRY INDRA PRC |
| Entity Type: | Individual |
| Taxonomy Code: | 175T00000X |
| Specialty: | Peer Specialist |
| License Number: |
Most Important Dates
| Enumeration Date: | 02/02/2023 |
| Last Updated: | 02/02/2023 |
Provider Practice Location
765 E HAMILTON AVE
FLINT
MI
485054707
Practice Location Phone/Fax
| Phone: | 8102335340 |
| Fax: |
Provider Mailing Location
765 E HAMILTON AVE
FLINT
MI
485054707
Provider Mailing Phone/Fax
| Phone: | 8102335340 |
| Fax: |