Provider Demographics
NPI:1336125079
Name:JENTER, MARTIN WILLIAM (DO)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:WILLIAM
Last Name:JENTER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26850 PROVIDENCE PKWY
Mailing Address - Street 2:SUITE 355
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48374-1209
Mailing Address - Country:US
Mailing Address - Phone:248-347-2435
Mailing Address - Fax:248-347-3608
Practice Address - Street 1:26850 PROVIDENCE PKWY
Practice Address - Street 2:SUITE 355
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48374-1209
Practice Address - Country:US
Practice Address - Phone:248-347-2435
Practice Address - Fax:248-347-3608
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101011365207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI200F318000OtherBCBSM PRACTICE PIN
MI4791638Medicaid
MI383607217OtherP.C. TAX ID
MI4791638Medicaid
MION30870003Medicare PIN