Provider Demographics
NPI:1013094796
Name:JEFFREY JENNINGS MC PC
Entity Type:Organization
Organization Name:JEFFREY JENNINGS MC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:JENNINGS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-726-0340
Mailing Address - Street 1:134 W UNIVERSITY DR
Mailing Address - Street 2:STE 202
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48307-1951
Mailing Address - Country:US
Mailing Address - Phone:586-726-0340
Mailing Address - Fax:586-254-3872
Practice Address - Street 1:134 W UNIVERSITY DR
Practice Address - Street 2:STE 202
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48307-1951
Practice Address - Country:US
Practice Address - Phone:586-726-0340
Practice Address - Fax:586-254-3872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI045321207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1560341Medicaid
MI0634002Medicare PIN
MIB45321Medicare UPIN