Healthcare Provider Details

I. General information

NPI: 1790738193
Provider Name (Legal Business Name): RHONDA MEJEUR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 08/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 CHERRY ST SE STE 100
GRAND RAPIDS MI
49503-4607
US

IV. Provider business mailing address

245 STATE ST SE
GRAND RAPIDS MI
49503-4328
US

V. Phone/Fax

Practice location:
  • Phone: 616-685-3200
  • Fax: 616-458-3526
Mailing address:
  • Phone: 616-685-8050
  • Fax: 616-685-1850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301068483
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: