Healthcare Provider Details

I. General information

NPI: 1407839277
Provider Name (Legal Business Name): JENNIFER L RAFFIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2005
Last Update Date: 07/19/2022
Certification Date: 07/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 SOUTH BLVD EAST STE 240
ROCHESTER HILLS MI
48307
US

IV. Provider business mailing address

1701 SOUTH BLVD EAST STE 240
ROCHESTER HILLS MI
48307
US

V. Phone/Fax

Practice location:
  • Phone: 248-997-7000
  • Fax: 248-997-7007
Mailing address:
  • Phone: 248-997-7000
  • Fax: 248-997-7007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301078029
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: