Provider Demographics
NPI:1518263557
Name:BALAWENDER, JENIFER LINDSEY SHREVE (DO)
Entity Type:Individual
Prefix:DR
First Name:JENIFER
Middle Name:LINDSEY SHREVE
Last Name:BALAWENDER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 STRATHMORE RD
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910-2806
Mailing Address - Country:US
Mailing Address - Phone:219-369-3555
Mailing Address - Fax:
Practice Address - Street 1:2909 E GRAND RIVER AVE
Practice Address - Street 2:SUITE 211
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-4300
Practice Address - Country:US
Practice Address - Phone:517-364-8686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-09
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101018074207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine