Provider Demographics
NPI:1437378767
Name:LAFOREST, JESSICA L (MD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:LAFOREST
Suffix:
Gender:F
Credentials:MD
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Other - Last Name:
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Mailing Address - Street 1:1457 N M 52 STE 2
Mailing Address - Street 2:
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867-1519
Mailing Address - Country:US
Mailing Address - Phone:989-729-4292
Mailing Address - Fax:989-725-9012
Practice Address - Street 1:1457 N M 52 STE 2
Practice Address - Street 2:
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867
Practice Address - Country:US
Practice Address - Phone:989-729-4292
Practice Address - Fax:989-725-9012
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301097612207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1437378767Medicaid
MI1437378767Medicaid