Healthcare Provider Details

I. General information

NPI: 1487761284
Provider Name (Legal Business Name): JENNIFER SUE ENGLE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 11/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3290 WEST BIG BEAVER SUITE 410
TROY MI
48084
US

IV. Provider business mailing address

3290 W BIG BEAVER SUITE 410
TROY MI
48084
US

V. Phone/Fax

Practice location:
  • Phone: 248-816-6300
  • Fax: 248-816-6335
Mailing address:
  • Phone: 248-816-6300
  • Fax: 248-816-6335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number4301056164
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: