Healthcare Provider Details

I. General information

NPI: 1225008782
Provider Name (Legal Business Name): WILLIAM J VENEMA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 11/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5629 STADIUM DR BRONSON RAMBLING ROAD PEDIATRICS
KALAMAZOO MI
49009-1952
US

IV. Provider business mailing address

601 JOHN ST BOX 42
KALAMAZOO MI
49007-5341
US

V. Phone/Fax

Practice location:
  • Phone: 269-371-1000
  • Fax: 269-372-0698
Mailing address:
  • Phone: 269-341-7806
  • Fax: 269-341-8743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301025837
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: