Provider Demographics
NPI:1699724302
Name:MESSENGER, JEFFREY LEONARD (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:LEONARD
Last Name:MESSENGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9099 E LANSING RD
Mailing Address - Street 2:
Mailing Address - City:DURAND
Mailing Address - State:MI
Mailing Address - Zip Code:48429-1083
Mailing Address - Country:US
Mailing Address - Phone:989-288-1800
Mailing Address - Fax:989-288-3300
Practice Address - Street 1:9099 E LANSING RD
Practice Address - Street 2:
Practice Address - City:DURAND
Practice Address - State:MI
Practice Address - Zip Code:48429-1083
Practice Address - Country:US
Practice Address - Phone:989-288-1800
Practice Address - Fax:989-288-3300
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJM048598207N00000X, 207ND0101X, 207ND0900X, 207NI0002X, 207NP0225X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No207NI0002XAllopathic & Osteopathic PhysiciansDermatologyClinical & Laboratory Dermatological Immunology
No207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric Dermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1664892Medicaid
MIJM048598OtherSTATE LICENSE
MI03 00013OtherPHP OF MICHIGAN
MI03 00013OtherPHP OF MICHIGAN
MIC36066008Medicare ID - Type Unspecified
MIJM048598OtherSTATE LICENSE