Provider Demographics
NPI:1952561565
Name:BURGESS, JENNIFER MARIE (DO)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:MARIE
Last Name:BURGESS
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:8391 COMMERCE RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:COMMERCE TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48382-4489
Mailing Address - Country:US
Mailing Address - Phone:248-360-8100
Mailing Address - Fax:248-360-8018
Practice Address - Street 1:8391 COMMERCE RD
Practice Address - Street 2:SUITE 108
Practice Address - City:COMMERCE TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48382-4489
Practice Address - Country:US
Practice Address - Phone:248-360-8100
Practice Address - Fax:248-360-8018
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-17
Last Update Date:2021-03-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101017695207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine