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General NPI Number Information
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NPI Number | 1609864164
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Entity Type | Individual
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Provider Name | JENNIFER LYNN DEAR M.D.
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Gender | Female
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Dates
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Enumeration Date | 10/10/2005
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Last Update Date | 02/11/2021
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Provider Practice Location Address
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Address Line | 5000 HAKES DR
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City | NORTON SHORES
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State | MI
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Zip | 49441-5574
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Country | US
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Telephone | 231-798-4445
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Fax | 231-798-4462
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Provider Business Mailing Address
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Address Line | 5000 HAKES DR
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City | NORTON SHORES
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State | MI
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Zip | 49441-5574
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Country | US
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Telephone | 231-798-4445
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Fax | 231-798-4462
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 01056316A
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License Number State | IN
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