Individual
JENNIFER PLATKUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
22250 PROVIDENCE DR, STE 406, SOUTHFIELD, MI 48075-4825
(248) 557-9010
(248) 557-3655
Mailing address
22250 PROVIDENCE DR, STE 406, SOUTHFIELD, MI 48075-4825
(248) 557-9010
(248) 557-3655
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
4704195094
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4579525
—
MI
01
—
5008602800
BLUE CROSS BLUE SHIELD
MI
Enumeration date
09/19/2005
Last updated
03/07/2023
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