Provider Demographics
NPI:1609864164
Name:DEAR, JENNIFER LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LYNN
Last Name:DEAR
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 1:5000 HAKES DR
Mailing Address - Street 2:
Mailing Address - City:NORTON SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:49441-5574
Mailing Address - Country:US
Mailing Address - Phone:231-798-4445
Mailing Address - Fax:231-798-4462
Practice Address - Street 1:5000 HAKES DR
Practice Address - Street 2:
Practice Address - City:NORTON SHORES
Practice Address - State:MI
Practice Address - Zip Code:49441-5574
Practice Address - Country:US
Practice Address - Phone:231-798-4445
Practice Address - Fax:231-798-4462
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01056316A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN00000063937OtherBCBS
IN000000685042OtherBCBS
MI4301099906OtherMI LICENSE
IN200386980Medicaid
INH71889Medicare UPIN
IN200386980Medicaid