Provider Demographics
NPI:1548269897
Name:JENKINS, TESSY C (MD)
Entity type:Individual
Prefix:DR
First Name:TESSY
Middle Name:C
Last Name:JENKINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27200 LAHSER RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034
Mailing Address - Country:US
Mailing Address - Phone:248-208-9215
Mailing Address - Fax:248-208-9217
Practice Address - Street 1:27200 LAHSER RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034
Practice Address - Country:US
Practice Address - Phone:248-208-9215
Practice Address - Fax:248-208-9217
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-19
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010585682084N0400X, 2084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5535883OtherFIRST HEALTH
MI1306303571OtherBCBS
MI4639614Medicaid
MIP111695OtherBLUECARE NETWORK
MI7794125OtherAETNA
MIG35452OtherHEALTH ALLIANCE PLAN
MI4639614Medicaid
MIG35452OtherHEALTH ALLIANCE PLAN