Healthcare Provider Details

I. General information

NPI: 1982820023
Provider Name (Legal Business Name): JESSA KRISTEN EDELMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSA KRISTEN WALKER M.D.

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2799 W GRAND BLVD # 1
DETROIT MI
48202-2608
US

IV. Provider business mailing address

PO BOX 670884
DETROIT MI
48267-0884
US

V. Phone/Fax

Practice location:
  • Phone: 313-916-8144
  • Fax:
Mailing address:
  • Phone: 800-436-7936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number4301083962
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301083962
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: