Individual
JESSICA RAE PRUENTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2205 COMMONWEALTH, ANN ARBOR, MI 48105-2945
(734) 936-7175
Mailing address
3621 S STATE ST, ANN ARBOR, MI 48108-1633
(734) 647-5299
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
125.061297
IL
208100000X
Physical Medicine & Rehabilitation Physician
Primary
4301114645
MI
Other
Enumeration date
06/27/2012
Last updated
02/25/2020
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