Individual
JENEAL M DUFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2373 64TH ST SW STE 1300, BYRON CENTER, MI 49315-7975
(872) 588-3000
Mailing address
2743 OLIVIA ST NW, GRAND RAPIDS, MI 49504-5894
(317) 670-2912
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
085006970
IL
363AM0700X
Medical Physician Assistant
085.006970
IL
363AM0700X
Medical Physician Assistant
Primary
5601012103
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
085006970
STATE LICENSE
IL
01
—
1159852
SPECIALTY BOARDS
IL
01
—
385005452
CS LICENSE
IL
01
—
5315244931
CS LICENSE
MI
01
—
5601012103
STATE LICENSE
MI
Enumeration date
03/13/2019
Last updated
01/23/2024
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