1235524471 NPI number — DR. JENNIFER LEE STEIN MD

Table of content: DR. JENNIFER LEE STEIN MD (NPI 1235524471)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235524471 NPI number — DR. JENNIFER LEE STEIN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STEIN
Provider First Name:
JENNIFER
Provider Middle Name:
LEE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KRANINGER
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
LEE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1235524471
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/29/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
632 BONNIE BRAE PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RIVER FOREST
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60305-1929
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
262-215-0910
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2215 FULLER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANN ARBOR
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48105-2303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-769-7100
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/04/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X , with the licence number:  K65543288653 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 4301502899 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)