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General NPI Number Information
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NPI Number | 1508077165
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Entity Type | Organization
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Legal Business Name | ROBERT DEJONGE DO PC
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Dates
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Enumeration Date | 05/25/2007
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Last Update Date | 06/17/2008
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Provider Practice Location Address
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Address Line | 350 NORTHLAND DR NE
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City | ROCKFORD
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State | MI
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Zip | 49341-1401
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Country | US
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Telephone | 616-866-4474
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Fax | 616-866-4476
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Provider Business Mailing Address
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Address Line | 350 NORTHLAND DR NE
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City | ROCKFORD
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State | MI
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Zip | 49341-1401
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Country | US
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Telephone | 616-866-4474
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Fax | 616-866-4476
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ROBERT DEJONGE
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Credential | DO
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Telephone | 616-866-4474
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 5101007920
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License Number State | MI
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