Provider Demographics
NPI:1588648539
Name:LEINO, JENNIFER A (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:A
Last Name:LEINO
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 1:419 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:MANCELONA
Mailing Address - State:MI
Mailing Address - Zip Code:49659-9651
Mailing Address - Country:US
Mailing Address - Phone:231-587-9181
Mailing Address - Fax:231-587-0923
Practice Address - Street 1:419 W STATE ST
Practice Address - Street 2:
Practice Address - City:MANCELONA
Practice Address - State:MI
Practice Address - Zip Code:49659
Practice Address - Country:US
Practice Address - Phone:231-587-9181
Practice Address - Fax:231-587-0923
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301078074207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4748898Medicaid
MI4748898Medicaid