Provider Demographics
NPI:1457511040
Name:SHIH, JENNY PHU (DO)
Entity Type:Individual
Prefix:DR
First Name:JENNY
Middle Name:PHU
Last Name:SHIH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:JENNY
Other - Middle Name:YEE-NGOI
Other - Last Name:PHU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:7700 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-2411
Mailing Address - Country:US
Mailing Address - Phone:313-202-8660
Mailing Address - Fax:313-202-8653
Practice Address - Street 1:21040 GREENFIELD RD
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-3025
Practice Address - Country:US
Practice Address - Phone:248-967-6538
Practice Address - Fax:248-967-6552
Is Sole Proprietor?:No
Enumeration Date:2008-06-17
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101017681207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI700H231390OtherBCBS GROUP NUMBER
MI0P47270Medicare PIN