Provider Demographics
NPI:1215913397
Name:DRIKER, JENNIFER B (MD MPH)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:B
Last Name:DRIKER
Suffix:
Gender:F
Credentials:MD MPH
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:BOOKSTEIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:555 W 14 MILE RD
Mailing Address - Street 2:STE 100
Mailing Address - City:CLAWSON
Mailing Address - State:MI
Mailing Address - Zip Code:48017-3100
Mailing Address - Country:US
Mailing Address - Phone:248-655-1400
Mailing Address - Fax:248-655-2646
Practice Address - Street 1:555 W 14 MILE RD
Practice Address - Street 2:STE 100
Practice Address - City:CLAWSON
Practice Address - State:MI
Practice Address - Zip Code:48017-3100
Practice Address - Country:US
Practice Address - Phone:248-655-1400
Practice Address - Fax:248-655-2646
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-20
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301077619207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
M73660005Medicare ID - Type Unspecified
H24624Medicare UPIN