MEDICARE: JAIME HALVERSON DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	5101014826	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447205273
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAIME HALVERSON DO

Provider Business Mailing Address
First Line	:	245 STATE ST SE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49503-4328
Country	:	US
Telephone Number	:	616-685-1808
Fax Number	:	616-685-1850

Provider Business Practice Location Address
First Line	:	1175 WILSON AVE NW
Second Line	:
City	:	WALKER
State	:	MI
Zip	:	49534-3493
Country	:	US
Telephone Number	:	616-685-8650
Fax Number	:	616-791-2160

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	06/26/2009

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Directions to “ JAIME HALVERSON DO” Practice Location

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