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NPI Code Detail

MEDICARE: MRS. JENNIFER S OPDYCKE PAC

MEDICARE: MRS. JENNIFER S OPDYCKE PAC
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
1363AS0400XSurgical Physician Assistant5601004149MI
2363A00000XPhysician Assistant5601004149MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11104840529OTHERMIBCBSM - BMG
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1952358160
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JENNIFER S OPDYCKE PAC
Provider Business Mailing Address
First Line : 5708 VENTURE CT STE A
Second Line :
City : KALAMAZOO
State : MI
Zip : 49009-2858
Country : US
Telephone Number : 269-220-0648
Fax Number : 269-220-3535
Provider Business Practice Location Address
First Line : 5708 VENTURE CT STE A
Second Line :
City : KALAMAZOO
State : MI
Zip : 49009-2858
Country : US
Telephone Number : 269-220-0648
Fax Number : 269-220-3535
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/31/2006
Last Update Date : 01/12/2024

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Directions to “ MRS. JENNIFER S OPDYCKE PAC” Practice Location

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