Healthcare Provider Details

I. General information

NPI: 1316047830
Provider Name (Legal Business Name): JENNIFER L VAN ZEE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2006
Last Update Date: 12/13/2022
Certification Date: 12/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 KENMOOR AVE SE SUITE 110
GRAND RAPIDS MI
49546-2379
US

IV. Provider business mailing address

721 KENMOOR AVE SE
GRAND RAPIDS MI
49546-2306
US

V. Phone/Fax

Practice location:
  • Phone: 616-949-6112
  • Fax: 616-949-8530
Mailing address:
  • Phone: 616-949-6112
  • Fax: 616-949-8530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301072311
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: