Healthcare Provider Details

I. General information

NPI: 1215913397
Provider Name (Legal Business Name): JENNIFER B DRIKER MD MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNIFER BOOKSTEIN

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 08/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 W 14 MILE RD STE 100
CLAWSON MI
48017-3100
US

IV. Provider business mailing address

555 W 14 MILE RD STE 100
CLAWSON MI
48017-3100
US

V. Phone/Fax

Practice location:
  • Phone: 248-655-1400
  • Fax: 248-655-2646
Mailing address:
  • Phone: 248-655-1400
  • Fax: 248-655-2646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301077619
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: