Provider Demographics
NPI:1083735773
Name:HAENER, JENNIFER R (DO)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:R
Last Name:HAENER
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:2940 CROOKS ROAD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309
Mailing Address - Country:US
Mailing Address - Phone:248-997-9700
Mailing Address - Fax:248-997-9707
Practice Address - Street 1:2940 CROOKS ROAD
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48309
Practice Address - Country:US
Practice Address - Phone:586-843-3935
Practice Address - Fax:586-843-3947
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2023-03-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101016120207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
N22160008Medicare UPIN