Provider Demographics
NPI:1477531929
Name:FRETZ, JENNIFER ELISE (DO)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ELISE
Last Name:FRETZ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1570 KINGSWAY CT STE 1
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48183-1961
Mailing Address - Country:US
Mailing Address - Phone:833-373-7389
Mailing Address - Fax:734-301-3132
Practice Address - Street 1:1570 KINGSWAY CT STE 1
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:MI
Practice Address - Zip Code:48183-1961
Practice Address - Country:US
Practice Address - Phone:833-373-7389
Practice Address - Fax:734-301-3132
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2023-11-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101012064207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1477531929OtherCOMMERCIAL INSURANCE
MI1679755037Medicaid
MI0858205524OtherBCBS