Provider Demographics
NPI:1629017157
Name:MICHAELS, JENNY R (MD MPH)
Entity Type:Individual
Prefix:DR
First Name:JENNY
Middle Name:R
Last Name:MICHAELS
Suffix:
Gender:F
Credentials:MD MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:42350 GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-1838
Mailing Address - Country:US
Mailing Address - Phone:248-697-2942
Mailing Address - Fax:248-436-6628
Practice Address - Street 1:42350 GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-1838
Practice Address - Country:US
Practice Address - Phone:248-697-2942
Practice Address - Fax:248-436-6628
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301078008208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4885117Medicaid
MI0Q26007046Medicare PIN
MI4885117Medicaid