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NPI Code Detail

MEDICARE: JESSICA ELAINE LIGGETT MD

MEDICARE: JESSICA ELAINE LIGGETT MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207ND0900XDermatopathology Physician4301088493MI
2207N00000XDermatology Physician4301088493MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
24301088493OTHERMISTATE LICENSE

General Provider Information

NPI Number : 1619179710
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA ELAINE LIGGETT MD
Provider Business Mailing Address
First Line : 3000 OLD CENTRE RD
Second Line :
City : PORTAGE
State : MI
Zip : 49024-4883
Country : US
Telephone Number : 269-321-7546
Fax Number : 693-211-7052
Provider Business Practice Location Address
First Line : 3000 OLD CENTRE RD
Second Line :
City : PORTAGE
State : MI
Zip : 49024-4883
Country : US
Telephone Number : 269-321-7546
Fax Number : 269-321-1705
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2007
Last Update Date : 01/31/2023

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Directions to “ JESSICA ELAINE LIGGETT MD” Practice Location

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