Individual
JENNIFER CASTILLO PODGORNY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
18181 OAKWOOD BLVD STE 403, DEARBORN, MI 48124-3960
(313) 438-5560
(313) 438-5575
Mailing address
25500 MEADOWBROOK RD STE 150, NOVI, MI 48375-1880
(248) 784-3667
(248) 869-3982
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5601005056
STATE LICENSE
MI
Enumeration date
06/13/2007
Last updated
03/05/2025
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