Provider Demographics
NPI:1518175116
Name:CAUDILL, JENNIFER TREPTE (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:TREPTE
Last Name:CAUDILL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5885 S. MAIN ST.
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346
Mailing Address - Country:US
Mailing Address - Phone:248-623-9700
Mailing Address - Fax:248-623-8996
Practice Address - Street 1:5885 S. MAIN ST.
Practice Address - Street 2:SUITE 1
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346
Practice Address - Country:US
Practice Address - Phone:248-623-9700
Practice Address - Fax:248-623-8996
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301086079207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology