MEDICARE: DR. JENNIFER LYNN DEAR M.D.

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	207Q00000X	Family Medicine Physician	01056316A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00000063937	OTHER	IN	BCBS
2	000000685042	OTHER	IN	BCBS
3	4301099906	OTHER	MI	MI LICENSE
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609864164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER LYNN DEAR M.D.

Provider Business Mailing Address
First Line	:	5000 HAKES DR
Second Line	:
City	:	NORTON SHORES
State	:	MI
Zip	:	49441-5574
Country	:	US
Telephone Number	:	231-798-4445
Fax Number	:	231-798-4462

Provider Business Practice Location Address
First Line	:	5000 HAKES DR
Second Line	:
City	:	NORTON SHORES
State	:	MI
Zip	:	49441-5574
Country	:	US
Telephone Number	:	231-798-4445
Fax Number	:	231-798-4462

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

Provider Enumeration Date	:	10/10/2005
Last Update Date	:	02/11/2021

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