Provider Demographics
NPI:1104059708
Name:HWANG, JENNIFER MARIE (DO)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:MARIE
Last Name:HWANG
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:1721 S STEPHENSON AVE
Mailing Address - Street 2:
Mailing Address - City:IRON MOUNTAIN
Mailing Address - State:MI
Mailing Address - Zip Code:49801-3637
Mailing Address - Country:US
Mailing Address - Phone:906-774-1313
Mailing Address - Fax:906-776-5639
Practice Address - Street 1:1711 S STEPHENSON AVE
Practice Address - Street 2:STE 115
Practice Address - City:IRON MOUNTAIN
Practice Address - State:MI
Practice Address - Zip Code:49801-3639
Practice Address - Country:US
Practice Address - Phone:906-776-5970
Practice Address - Fax:906-228-0215
Is Sole Proprietor?:No
Enumeration Date:2009-08-29
Last Update Date:2018-10-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101018418207R00000X
NY295621207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO0053917OtherMEDICAL
MI5101018418OtherLICENSE