Provider Demographics
NPI:1154945558
Name:JOHENGEN, JACOB THOMAS (DO)
Entity type:Individual
Prefix:DR
First Name:JACOB
Middle Name:THOMAS
Last Name:JOHENGEN
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:24 FRANK LLOYD WRIGHT DR # J2000
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-9484
Mailing Address - Country:US
Mailing Address - Phone:734-747-6766
Mailing Address - Fax:734-222-3100
Practice Address - Street 1:870 E ARKONA RD STE 100
Practice Address - Street 2:
Practice Address - City:MILAN
Practice Address - State:MI
Practice Address - Zip Code:48160-9770
Practice Address - Country:US
Practice Address - Phone:734-439-2429
Practice Address - Fax:734-439-0200
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-01
Last Update Date:2023-06-23
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Provider Licenses
StateLicense IDTaxonomies
MI5151014543207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine