Provider Demographics
NPI:1316956345
Name:GREENFIELD, JODI L (DO)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:L
Last Name:GREENFIELD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6285 E.5 RD
Mailing Address - Street 2:
Mailing Address - City:BARK RIVER
Mailing Address - State:MI
Mailing Address - Zip Code:49807-9544
Mailing Address - Country:US
Mailing Address - Phone:906-280-8142
Mailing Address - Fax:
Practice Address - Street 1:6285 E.5 RD
Practice Address - Street 2:
Practice Address - City:BARK RIVER
Practice Address - State:MI
Practice Address - Zip Code:49807-9544
Practice Address - Country:US
Practice Address - Phone:906-280-8142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101013039207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4140903Medicaid
MI080144817OtherRR MEDICARE GROUP#CC2139
MI4140903Medicaid
MI0M05250023Medicare ID - Type Unspecified