Individual
JENNIFER J PARKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1035 E WILCOX AVE, WHITE CLOUD, MI 49349
(231) 689-5943
(231) 689-1590
Mailing address
117 W PATERSON ST, KALAMAZOO, MI 49007-2557
(269) 349-2641
(269) 466-5522
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
01072082A
IN
207Q00000X
Family Medicine Physician
Primary
JP080605
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
08-070-11602
BCBS
MI
05
—
201135770
—
IN
01
—
383218134
TRICARE
MI
05
—
5217469
—
MI
Enumeration date
07/18/2006
Last updated
09/04/2019
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