Healthcare Provider Details

I. General information

NPI: 1730534074
Provider Name (Legal Business Name): JENNIFER KUO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2016
Last Update Date: 07/31/2024
Certification Date: 08/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14650 E OLD US HIGHWAY 12 STE 303
CHELSEA MI
48118
US

IV. Provider business mailing address

24 FRANK LLOYD WRIGHT DRIVE J2000
ANN ARBOR MI
48105
US

V. Phone/Fax

Practice location:
  • Phone: 734-712-8100
  • Fax: 734-887-8942
Mailing address:
  • Phone: 734-747-6766
  • Fax: 734-222-3100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number4301506848
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: