Provider Demographics
NPI:1912940826
Name:JOSEPH, JENNIFER LYNN (DO)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNN
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:JOSEPH
Other - Last Name:LEWANDOWSKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:1540 LAKE LANSING ROAD
Mailing Address - Street 2:98POINT6 EMERGICENTER
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912
Mailing Address - Country:US
Mailing Address - Phone:517-913-6711
Mailing Address - Fax:517-913-6712
Practice Address - Street 1:1540 LAKE LANSING RD
Practice Address - Street 2:98POINT6 EMERGICENTER
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-3756
Practice Address - Country:US
Practice Address - Phone:517-913-6711
Practice Address - Fax:517-913-6712
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101014313207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H97142Medicare UPIN