Provider Demographics
NPI:1750343406
Name:HOLAN, JENNIFER LYNN (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LYNN
Last Name:HOLAN
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 1:1750 S TELEGRAPH RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-0166
Mailing Address - Country:US
Mailing Address - Phone:248-858-2202
Mailing Address - Fax:248-334-4517
Practice Address - Street 1:1750 S TELEGRAPH RD
Practice Address - Street 2:SUITE 108
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-0166
Practice Address - Country:US
Practice Address - Phone:248-858-2202
Practice Address - Fax:248-334-4517
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJH062815207V00000X
AZ22616207V00000X
CAG80257207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3084274Medicaid
0M00270Medicare ID - Type Unspecified
G08006Medicare UPIN