Provider Demographics
NPI:1982617247
Name:PINNEY, JACK (MD)
Entity Type:Individual
Prefix:
First Name:JACK
Middle Name:
Last Name:PINNEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:4401 N CAMPUS RIDGE DR
Mailing Address - Street 2:SUITE C2000
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-6112
Mailing Address - Country:US
Mailing Address - Phone:989-837-9350
Mailing Address - Fax:989-837-9347
Practice Address - Street 1:4401 N CAMPUS RIDGE DR
Practice Address - Street 2:SUITE C2000
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-6112
Practice Address - Country:US
Practice Address - Phone:989-837-9350
Practice Address - Fax:989-837-9347
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2014-11-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MIJP047507207Q00000X
MI4301047507207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIB43207Medicare UPIN
MI0E66005008Medicare PIN