Provider Demographics
NPI:1841357530
Name:SOMERS, JENNIFER LYNN (DPM)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNN
Last Name:SOMERS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6483 CITATION DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-2994
Mailing Address - Country:US
Mailing Address - Phone:248-751-1025
Mailing Address - Fax:248-922-9368
Practice Address - Street 1:6483 CITATION DR
Practice Address - Street 2:SUITE A
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-2994
Practice Address - Country:US
Practice Address - Phone:248-751-1025
Practice Address - Fax:248-922-9368
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901002185213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1841357530OtherTRICARE
MI480E015590OtherBLUE CROSS AND BLUE SHIEL
MI4977980OtherTOTAL HEALTH CARE
MI135073500OtherWORKER COMPENSATION
811546797OtherTAX ID
MIP00405158OtherRAIL ROAD MEDICARE
MI4977980Medicaid
MI5901002185OtherSTATE LICENSE
MI160088OtherGREAT LAKES
MI4977980OtherOMNICARE
MI6U5660OtherHEALTH ALLIANCE PLAN
MI7840927OtherAETNA
MIDB8851OtherRAIL ROAD MEDICARE GRP
MI0E06293OtherMEDICARE GROUP
MI4855010950OtherBLUE CROSS AND BLUE SHIEL
MI135073500OtherWORKER COMPENSATION
MI160088OtherGREAT LAKES