Healthcare Provider Details

I. General information

NPI: 1124381462
Provider Name (Legal Business Name): JENNATA FRANCIS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2012
Last Update Date: 09/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2331 MONROE ST
DEARBORN MI
48124-3009
US

IV. Provider business mailing address

2331 MONROE ST
DEARBORN MI
48124-3009
US

V. Phone/Fax

Practice location:
  • Phone: 313-792-0345
  • Fax: 313-792-0346
Mailing address:
  • Phone: 313-792-0345
  • Fax: 313-792-0346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301100863
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: