Provider Demographics
NPI:1114238037
Name:ZACUR, JENNIFER LYNN (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LYNN
Last Name:ZACUR
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:LYNN
Other - Last Name:REEVE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, PHD
Mailing Address - Street 1:420 N MAIN ST STE 600
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:MI
Mailing Address - Zip Code:48118-1299
Mailing Address - Country:US
Mailing Address - Phone:734-385-7255
Mailing Address - Fax:
Practice Address - Street 1:420 N MAIN ST STE 600
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:MI
Practice Address - Zip Code:48118-1299
Practice Address - Country:US
Practice Address - Phone:734-385-7255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-24
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA258123207N00000X
MI4301106935207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology