Provider Demographics
NPI:1255423620
Name:JENNINGS, GEORGE SCOTT (DO)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:SCOTT
Last Name:JENNINGS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28080 GRAND RIVER AVE
Mailing Address - Street 2:208 N
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-5966
Mailing Address - Country:US
Mailing Address - Phone:248-478-7733
Mailing Address - Fax:248-478-3533
Practice Address - Street 1:28080 GRAND RIVER AVE
Practice Address - Street 2:208 N
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336-5966
Practice Address - Country:US
Practice Address - Phone:248-478-7733
Practice Address - Fax:248-478-3533
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIGJ007541208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3356314144OtherBCBC OF MI
MI183604811Medicaid
E25918Medicare UPIN
MI5632787Medicare PIN