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NPI Code Detail

MEDICARE: JENNIFER LYNN VACCA MD

MEDICARE: JENNIFER LYNN VACCA MD
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
1207R00000XInternal Medicine Physician48229CO
2207R00000XInternal Medicine Physician4301511266MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1528251873
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER LYNN VACCA MD
Provider Business Mailing Address
First Line : 401 HALL ST SW STE 263
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49503-4988
Country : US
Telephone Number : 616-719-0919
Fax Number : 616-719-0933
Provider Business Practice Location Address
First Line : 401 HALL ST SW STE 263
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49503-4988
Country : US
Telephone Number : 616-719-0919
Fax Number : 616-719-0933
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/21/2007
Last Update Date : 04/29/2024

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Directions to “ JENNIFER LYNN VACCA MD” Practice Location

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