Healthcare Provider Details

I. General information

NPI: 1386823771
Provider Name (Legal Business Name): JENNIFER MARIE KUIPER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2007
Last Update Date: 12/21/2020
Certification Date: 12/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 PARK AVE
FRANKFORT MI
49635-9658
US

IV. Provider business mailing address

224 PARK AVE
FRANKFORT MI
49635-9658
US

V. Phone/Fax

Practice location:
  • Phone: 231-352-2990
  • Fax: 231-352-2342
Mailing address:
  • Phone: 231-352-2990
  • Fax: 231-352-2342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301082282
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: