Healthcare Provider Details

I. General information

NPI: 1114213154
Provider Name (Legal Business Name): JESSICA DEANNE SEGEDY WHITE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA DEANNE SEGEDY DO

II. Dates (important events)

Enumeration Date: 06/28/2011
Last Update Date: 12/28/2020
Certification Date: 12/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6210 W MAIN ST
KALAMAZOO MI
49009-8925
US

IV. Provider business mailing address

6210 W MAIN ST
KALAMAZOO MI
49009-8925
US

V. Phone/Fax

Practice location:
  • Phone: 269-286-7030
  • Fax: 269-286-7031
Mailing address:
  • Phone: 269-286-7030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number5101019470
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: