Provider Demographics
NPI:1952453474
Name:CARMAN, JENNIFER MARGARET (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:MARGARET
Last Name:CARMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:MARAGRET
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3300 W CENTRE AVE
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-4666
Mailing Address - Country:US
Mailing Address - Phone:269-327-2211
Mailing Address - Fax:269-327-0273
Practice Address - Street 1:3300 W CENTRE AVE
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-4666
Practice Address - Country:US
Practice Address - Phone:269-327-2211
Practice Address - Fax:269-327-0273
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301081704207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1417961137OtherBCBSM - BMH
MI1952453474Medicaid
MI5177480Medicaid
MI5177461Medicaid
MI5177470Medicaid
MI1235131137OtherBCBSM - BLH
MI5177499Medicaid
MI1104840529OtherBCBSM - BPM
MI1104840529OtherBCBSM - BPM
MI1952453474Medicaid
MI5177480Medicaid
MIH06012084 - BLHMedicare PIN