Individual
DR. ERIC ALF JENTOFT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1414 W FAIR AVE, SUITE 390, MARQUETTE, MI 49855-2675
(906) 225-3881
Mailing address
1414 W FAIR AVE, SUITE 390, MARQUETTE, MI 49855-2675
(906) 225-3881
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
4301081464
MI
207VG0400X
Gynecology Physician
4301081464
MI
207VX0000X
Obstetrics Physician
4301081464
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05201102
BC/BS
MI
05
—
5183941
—
MI
01
—
766711051208
PREFERRED ONE
MI
Enumeration date
05/24/2007
Last updated
02/20/2008
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