Provider Demographics
NPI:1518983006
Name:ATKINS, JENNIFER A (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:A
Last Name:ATKINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:850 N OTSEGO AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:GAYLORD
Mailing Address - State:MI
Mailing Address - Zip Code:49735-1568
Mailing Address - Country:US
Mailing Address - Phone:989-731-7777
Mailing Address - Fax:989-731-7776
Practice Address - Street 1:3860 S. STRAITS HIGHWAY
Practice Address - Street 2:
Practice Address - City:INDIAN RIVER
Practice Address - State:MI
Practice Address - Zip Code:49749
Practice Address - Country:US
Practice Address - Phone:231-238-0581
Practice Address - Fax:231-238-0586
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301071873208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3501600212OtherINDIVIDUAL BLUE CROSS
MI4369420Medicaid
MIOF96004OtherMEDICARE GROUP
MI700A610040OtherGROUP BLUE CROSS
MI4369420Medicaid