Provider Demographics
NPI:1710181813
Name:PODGORNY, JENNIFER CASTILLO (PA-C)
Entity Type:Individual
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First Name:JENNIFER
Middle Name:CASTILLO
Last Name:PODGORNY
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:18181 OAKWOOD BLVD
Mailing Address - Street 2:SUITE 411
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-5032
Mailing Address - Country:US
Mailing Address - Phone:313-982-5290
Mailing Address - Fax:313-982-5295
Practice Address - Street 1:18181 OAKWOOD BLVD
Practice Address - Street 2:SUITE 411
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-5032
Practice Address - Country:US
Practice Address - Phone:313-982-5290
Practice Address - Fax:313-982-5295
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2021-02-23
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant