Healthcare Provider Details

I. General information

NPI: 1003728767
Provider Name (Legal Business Name): MR. JEFF TUBERGEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5155 32ND AVE
HUDSONVILLE MI
49426-1716
US

IV. Provider business mailing address

3378 STEPHANIE DR
HUDSONVILLE MI
49426-7547
US

V. Phone/Fax

Practice location:
  • Phone: 616-808-9313
  • Fax:
Mailing address:
  • Phone: 616-808-9313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number6801085642
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: