Healthcare Provider Details

I. General information

NPI: 1518263557
Provider Name (Legal Business Name): JENIFER LINDSEY SHREVE BALAWENDER D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2011
Last Update Date: 02/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2909 E GRAND RIVER AVE SUITE 211
LANSING MI
48912-4300
US

IV. Provider business mailing address

219 STRATHMORE RD
LANSING MI
48910-2806
US

V. Phone/Fax

Practice location:
  • Phone: 517-364-8686
  • Fax:
Mailing address:
  • Phone: 219-369-3555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101018074
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: