Healthcare Provider Details

I. General information

NPI: 1447380217
Provider Name (Legal Business Name): JEAN JAFFKE, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 03/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46325 W 12 MILE SUITE 325
NOVI MI
48377
US

IV. Provider business mailing address

46325 W12 MILE RD SUITE 325
NOVI MI
48377
US

V. Phone/Fax

Practice location:
  • Phone: 248-662-4100
  • Fax: 248-380-8556
Mailing address:
  • Phone: 248-662-4100
  • Fax: 248-380-8556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberJJ061256
License Number StateMI

VIII. Authorized Official

Name: DR. JEAN A JAFFKE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 248-662-4100