MEDICARE: MISS JENNIFER MARIE PFEIFFER PHYSICIAN ASSISTANT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	5601004092	MI

General Provider Information

NPI Number	:	1477619518
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS JENNIFER MARIE PFEIFFER PHYSICIAN ASSISTANT

Provider Business Mailing Address
First Line	:	34862 HAZELWOOD ST
Second Line	:
City	:	WESTLAND
State	:	MI
Zip	:	48186-4446
Country	:	US
Telephone Number	:	847-863-6456
Fax Number	:

Provider Business Practice Location Address
First Line	:	6576 CHELSEA BRG
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-3072
Country	:	US
Telephone Number	:	313-567-2224
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/30/2006
Last Update Date	:	02/06/2021

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