Healthcare Provider Details

I. General information

NPI: 1447259783
Provider Name (Legal Business Name): WALTER JACQUEMIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 01/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21258 M 68 HWY
ONAWAY MI
49765-9692
US

IV. Provider business mailing address

PO BOX 427
HILLMAN MI
49746-0427
US

V. Phone/Fax

Practice location:
  • Phone: 989-733-2082
  • Fax: 989-733-8487
Mailing address:
  • Phone: 989-354-2197
  • Fax: 989-354-1952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number4301044354
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: