Provider Demographics
NPI:1467422618
Name:ELY, JENNIFER R (DO)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:R
Last Name:ELY
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Gender:F
Credentials:DO
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Mailing Address - Street 1:804 SERVICE RD
Mailing Address - Street 2:A201
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48824-7015
Mailing Address - Country:US
Mailing Address - Phone:517-884-2976
Mailing Address - Fax:517-432-3928
Practice Address - Street 1:1200 E MICHIGAN AVE
Practice Address - Street 2:SUITE 415
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-1800
Practice Address - Country:US
Practice Address - Phone:517-484-2760
Practice Address - Fax:517-484-3050
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2016-07-12
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Provider Licenses
StateLicense IDTaxonomies
MI5101014115207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4792321Medicaid
MI1467422618Medicaid
MI1467422618Medicaid
MI4792321Medicaid