Provider Demographics
NPI:1447380217
Name:JEAN JAFFKE, M.D., P.C.
Entity type:Organization
Organization Name:JEAN JAFFKE, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:JAFFKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-662-4100
Mailing Address - Street 1:46325 W12 MILE RD
Mailing Address - Street 2:SUITE 325
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377
Mailing Address - Country:US
Mailing Address - Phone:248-662-4100
Mailing Address - Fax:248-380-8556
Practice Address - Street 1:46325 W 12 MILE
Practice Address - Street 2:SUITE 325
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377
Practice Address - Country:US
Practice Address - Phone:248-662-4100
Practice Address - Fax:248-380-8556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJJ061256174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIG97482Medicare UPIN
MI0M83810Medicare ID - Type Unspecified
MI7704027OtherAETNA
MI124500OtherCARE CHOICES
MI6572152OtherCIGNA
MI2806334642OtherBCBSM
MIG97482Medicare UPIN