Provider Demographics
NPI:1043201098
Name:DOBLE, JENNIFER ELLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:ELLEN
Last Name:DOBLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2862 LESLIE PARK CIR
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-9254
Mailing Address - Country:US
Mailing Address - Phone:734-717-1412
Mailing Address - Fax:
Practice Address - Street 1:5333 MCAULEY DR
Practice Address - Street 2:SUITE R2009
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-1014
Practice Address - Country:US
Practice Address - Phone:734-712-0050
Practice Address - Fax:734-712-0055
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJD057676208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI250012974OtherMEDICARE RAILROAD
MI4387348Medicaid
MI250H110020OtherBCBS OF MICHIGAN
MI250012974OtherMEDICARE RAILROAD
MIG55844Medicare UPIN
MI4387348Medicaid