Provider Demographics
NPI:1487761284
Name:ENGLE, JENNIFER SUE (MD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:SUE
Last Name:ENGLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3290 W BIG BEAVER
Mailing Address - Street 2:SUITE 410
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084
Mailing Address - Country:US
Mailing Address - Phone:248-816-6300
Mailing Address - Fax:248-816-6335
Practice Address - Street 1:3290 WEST BIG BEAVER
Practice Address - Street 2:SUITE 410
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084
Practice Address - Country:US
Practice Address - Phone:248-816-6300
Practice Address - Fax:248-816-6335
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2009-11-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI43010561642086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0633076OtherBLUE CROSS BLUE SHIELD
MI0633076OtherBLUE CROSS BLUE SHIELD
G76743Medicare UPIN