Provider Demographics
NPI:1710199864
Name:CASTRO, JENNIFER GRAY (DO)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:GRAY
Last Name:CASTRO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:43205 WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-5006
Mailing Address - Country:US
Mailing Address - Phone:248-451-0600
Mailing Address - Fax:248-451-0700
Practice Address - Street 1:43205 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-5006
Practice Address - Country:US
Practice Address - Phone:248-451-0600
Practice Address - Fax:248-451-0700
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101016160208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics