Provider Demographics
NPI:1679746473
Name:SALINAS, JENNIFER SUSAN (MD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:SUSAN
Last Name:SALINAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:SUSAN
Other - Last Name:KUSHION
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:23513 N ROCKLEDGE
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-3758
Mailing Address - Country:US
Mailing Address - Phone:989-506-0578
Mailing Address - Fax:
Practice Address - Street 1:211 HIGHLAND CROSS DR
Practice Address - Street 2:SUITE 275
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77073-1733
Practice Address - Country:US
Practice Address - Phone:281-784-1500
Practice Address - Fax:281-209-8930
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-12
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301088331207P00000X
TXN3285207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX203869702Medicaid
TX0046DEOtherBCBSTX
TX1679746473OtherBCBSTX
TX1679746473OtherTRICARE SOUTH
TX203869701Medicaid
TXP00788546Medicare PIN
TX1679746473OtherBCBSTX
TXTXB150241Medicare PIN
TX8L16695Medicare PIN
TX8CB055Medicare PIN