Provider Demographics
NPI:1194068197
Name:DENENFELD, JACLYN ARIEL FRIEDMAN (MD)
Entity type:Individual
Prefix:DR
First Name:JACLYN
Middle Name:ARIEL FRIEDMAN
Last Name:DENENFELD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JACLYN
Other - Middle Name:ARIEL
Other - Last Name:FRIEDMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:100 MICHIGAN ST NE # MC845
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:25 MICHIGAN ST NE STE 6200
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-2577
Practice Address - Country:US
Practice Address - Phone:616-391-3304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-28
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301503363207V00000X
IL036.143874207V00000X
NY283197207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036.143874OtherMEDICAL LICENSE