Provider Demographics
NPI:1629021985
Name:BATTISTE, JENNIFER HARMON (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:HARMON
Last Name:BATTISTE
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 1:7115 KALAMAZOO AVE SE
Mailing Address - Street 2:SUITE A
Mailing Address - City:CALEDONIA
Mailing Address - State:MI
Mailing Address - Zip Code:49316
Mailing Address - Country:US
Mailing Address - Phone:616-583-0958
Mailing Address - Fax:616-583-0961
Practice Address - Street 1:7115 KALAMAZOO AVE SE
Practice Address - Street 2:SUITE A
Practice Address - City:CALEDONIA
Practice Address - State:MI
Practice Address - Zip Code:49316
Practice Address - Country:US
Practice Address - Phone:616-583-0958
Practice Address - Fax:616-583-0961
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301065950207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4320803Medicaid
MI4877124Medicaid
MI4289089Medicaid
MI4283693Medicaid
MI4289070Medicaid
MI4289089Medicaid
MI4877124Medicaid