Provider Demographics
NPI:1538138128
Name:YOUNGS, JENIFER K (DO)
Entity Type:Individual
Prefix:DR
First Name:JENIFER
Middle Name:K
Last Name:YOUNGS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JENIFER
Other - Middle Name:K
Other - Last Name:OSBO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:8485 ALGOMA AVE NE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-9102
Mailing Address - Country:US
Mailing Address - Phone:616-863-6220
Mailing Address - Fax:616-863-6221
Practice Address - Street 1:1200 56TH ST SW
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49509-9704
Practice Address - Country:US
Practice Address - Phone:616-243-5707
Practice Address - Fax:616-243-1170
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101013055208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA11285187OtherCAQH
MI4372926Medicaid
MI4372926Medicaid