Organization
THOMAS JOSEPH JENNINGS MD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS J JENNINGS M.D (PHYSICIAN)
(269) 982-4020
Entity
Organization
Contact information
Practice address
2824 S STATE ST, SAINT JOSEPH, MI 49085-2478
(269) 982-4020
(269) 982-4017
Mailing address
2824 S STATE ST, SAINT JOSEPH, MI 49085-2478
(269) 982-4020
(269) 982-4017
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
4301055947
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0110107
BLUE CROSS BLUE SHIELD MI
MI
01
—
0809937
SECURE HORIZON
MI
05
—
329013810
—
MI
Enumeration date
01/11/2008
Last updated
07/22/2008
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