Provider Demographics
NPI:1750418059
Name:PROHOW, JENNIFER MANKO (DO)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:MANKO
Last Name:PROHOW
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:3099 BROOKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48328-2595
Mailing Address - Country:US
Mailing Address - Phone:248-681-5890
Mailing Address - Fax:
Practice Address - Street 1:1455 S LAPEER RD
Practice Address - Street 2:SUITE 100
Practice Address - City:LAKE ORION
Practice Address - State:MI
Practice Address - Zip Code:48360-1467
Practice Address - Country:US
Practice Address - Phone:248-693-3551
Practice Address - Fax:248-693-4643
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101015830207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine