Provider Demographics
NPI:1508205162
Name:MICHELSON, JENNIFER LEIGH (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LEIGH
Last Name:MICHELSON
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1201 11TH AVE S STE 501
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-3423
Mailing Address - Country:US
Mailing Address - Phone:617-797-7365
Mailing Address - Fax:
Practice Address - Street 1:1201 11TH AVE S STE 501
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-3423
Practice Address - Country:US
Practice Address - Phone:205-930-0930
Practice Address - Fax:205-930-9050
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-17
Last Update Date:2017-10-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ALMD.35906207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology