Healthcare Provider Details

I. General information

NPI: 1255028460
Provider Name (Legal Business Name): JEREMIAH J VROEGINDEWEY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2023
Last Update Date: 04/18/2023
Certification Date: 04/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LAFAYETTE AVE SE STE 4000
GRAND RAPIDS MI
49503-4692
US

IV. Provider business mailing address

300 LAFAYETTE AVE SE STE 4000
GRAND RAPIDS MI
49503-4692
US

V. Phone/Fax

Practice location:
  • Phone: 616-685-6922
  • Fax:
Mailing address:
  • Phone: 616-685-6922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5151016107APP23
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: