Individual
DR. JENESE NICOLE REYNOLDS-GIBBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
24911 LITTLE MACK AVE, SUITE C, SAINT CLAIR SHORES, MI 48080-3200
(586) 777-2050
Mailing address
24911 LITTLE MACK AVE, SUITE C, SAINT CLAIR SHORES, MI 48080-3200
(586) 777-2050
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
125-053484
IL
207Q00000X
Family Medicine Physician
Primary
4301096049
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0H208910
BLUE CROSS GROUP
MI
Enumeration date
05/19/2008
Last updated
08/18/2017
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