Provider Demographics
NPI:1942294830
Name:LARKIN, JILL MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:MARIE
Last Name:LARKIN
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 1:3737 LANSING RD
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:MI
Mailing Address - Zip Code:48872-9773
Mailing Address - Country:US
Mailing Address - Phone:517-625-6911
Mailing Address - Fax:517-625-6962
Practice Address - Street 1:3737 LANSING RD
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:MI
Practice Address - Zip Code:48872-9773
Practice Address - Country:US
Practice Address - Phone:517-625-6911
Practice Address - Fax:517-625-6962
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-07
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301061402207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI434178810Medicaid
MI434178810Medicaid
MIG34260Medicare UPIN