Healthcare Provider Details

I. General information

NPI: 1083467401
Provider Name (Legal Business Name): JAGER HAAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2024
Last Update Date: 06/20/2025
Certification Date: 06/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3246 NORTH EVERGREEN DR. NE
GRAND RAPIDS MI
49525
US

IV. Provider business mailing address

100 MICHIGAN ST NE STE A601
GRAND RAPIDS MI
49503-2560
US

V. Phone/Fax

Practice location:
  • Phone: 616-459-7225
  • Fax: 616-459-7271
Mailing address:
  • Phone: 616-391-6243
  • Fax: 616-391-8611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number4351052982
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number4351052982
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: