Provider Demographics
NPI:1982040382
Name:OVERLY, JENNA NICOLE (MD)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:NICOLE
Last Name:OVERLY
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:26901 BEAUMONT BLVD STE 3D
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-3849
Mailing Address - Country:US
Mailing Address - Phone:947-522-1861
Mailing Address - Fax:947-522-0307
Practice Address - Street 1:44199 DEQUINDRE RD STE 315
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48085-1128
Practice Address - Country:US
Practice Address - Phone:248-964-1170
Practice Address - Fax:248-964-1188
Is Sole Proprietor?:No
Enumeration Date:2013-05-13
Last Update Date:2021-03-29
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Provider Licenses
StateLicense IDTaxonomies
MI4301117520208600000X, 2086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No208600000XAllopathic & Osteopathic PhysiciansSurgery