Provider Demographics
NPI:1710181813
Name:PODGORNY, JENNIFER CASTILLO (PA-C)
Entity type:Individual
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First Name:JENNIFER
Middle Name:CASTILLO
Last Name:PODGORNY
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:25500 MEADOWBROOK RD STE 150
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-1880
Mailing Address - Country:US
Mailing Address - Phone:248-784-3667
Mailing Address - Fax:248-869-3982
Practice Address - Street 1:18181 OAKWOOD BLVD STE 403
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-3960
Practice Address - Country:US
Practice Address - Phone:313-438-5560
Practice Address - Fax:313-438-5575
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2025-03-05
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5601005056OtherSTATE LICENSE