Provider Demographics
NPI:1164420014
Name:JAFFKE, JEAN ANNA (MD)
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:ANNA
Last Name:JAFFKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:46325 W TWELVE RD
Mailing Address - Street 2:SUITE 325
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377-2456
Mailing Address - Country:US
Mailing Address - Phone:248-662-4100
Mailing Address - Fax:248-380-8556
Practice Address - Street 1:46325 W 12 MILE RD
Practice Address - Street 2:325
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377-2456
Practice Address - Country:US
Practice Address - Phone:248-662-4100
Practice Address - Fax:248-380-8556
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2020-12-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MIJJ061256208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIG97482Medicare UPIN
MI122046OtherGREAT LAKES HEALTH PLAN
MI7704027OtherAETNA
MI0M83810Medicare ID - Type Unspecified
MI124500OtherPREFERRED/CARE CHOICES
MI4133284Medicaid
MI6572152OtherCIGNA
MIG97482Medicare UPIN