MEDICARE: DR. NADINE S JENNINGS 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	208100000X	Physical Medicine & Rehabilitation Physician	4301059614	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0634908	OTHER	MI	BCBSM
3	5549289	OTHER	MI	AETNA

General Provider Information

NPI Number	:	1851361711
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NADINE S JENNINGS M.D.

Provider Business Mailing Address
First Line	:	42557 WOODWARD AVE
Second Line	:	STE 130
City	:	BLOOMFIELD
State	:	MI
Zip	:	48304-5206
Country	:	US
Telephone Number	:	248-322-3088
Fax Number	:	248-322-4175

Provider Business Practice Location Address
First Line	:	2300 HAGGERTY RD STE 2150A
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48323-2192
Country	:	US
Telephone Number	:	248-926-6610
Fax Number	:	248-926-6611

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

Provider Enumeration Date	:	01/24/2006
Last Update Date	:	07/21/2022

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Directions to “ DR. NADINE S JENNINGS M.D.” Practice Location

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