Provider Demographics
NPI:1811982689
Name:WINEGARDEN, JEROME D (MD)
Entity type:Individual
Prefix:
First Name:JEROME
Middle Name:D
Last Name:WINEGARDEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:24 FRANK LLOYD WRIGHT DRIVE
Mailing Address - Street 2:SUITE J2000
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105
Mailing Address - Country:US
Mailing Address - Phone:734-747-6766
Mailing Address - Fax:734-222-3100
Practice Address - Street 1:5303 ELLIOTT DR.
Practice Address - Street 2:SUITE 210
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197
Practice Address - Country:US
Practice Address - Phone:734-712-1000
Practice Address - Fax:734-712-1012
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI081828207RH0003X
MI4301081828207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4611112Medicaid
MIH92985Medicare UPIN
MI0H16099009Medicare ID - Type Unspecified