Healthcare Provider Details

I. General information

NPI: 1023671138
Provider Name (Legal Business Name): EMMA JEAN HEPPLER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: EMMA JEAN JOHNSON DO

II. Dates (important events)

Enumeration Date: 04/16/2019
Last Update Date: 12/12/2024
Certification Date: 03/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5900 BYRON CENTER AVE SW
WYOMING MI
49519-9686
US

IV. Provider business mailing address

5900 BYRON CENTER AVE SW
WYOMING MI
49519-9686
US

V. Phone/Fax

Practice location:
  • Phone: 616-252-7137
  • Fax: 616-252-0304
Mailing address:
  • Phone: 616-252-7137
  • Fax: 616-252-0304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number5101026423
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: