Individual
MRS. JENNIFER S OPDYCKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
5708 VENTURE CT STE A, KALAMAZOO, MI 49009-2858
(269) 220-0648
(269) 220-3535
Mailing address
5708 VENTURE CT STE A, KALAMAZOO, MI 49009-2858
(269) 220-0648
(269) 220-3535
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601004149
MI
363AS0400X
Surgical Physician Assistant
5601004149
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1104840529
BCBSM - BMG
MI
05
—
1952358160
—
MI
Enumeration date
05/31/2006
Last updated
01/12/2024
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