Healthcare Provider Details

I. General information

NPI: 1164420014
Provider Name (Legal Business Name): JEAN ANNA JAFFKE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 12/29/2020
Certification Date: 12/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46325 W 12 MILE RD 325
NOVI MI
48377-2456
US

IV. Provider business mailing address

46325 W TWELVE RD SUITE 325
NOVI MI
48377-2456
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 Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberJJ061256
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: