MEDICARE: CHRISTOPHER LEE WEDEVEN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	4301074733	MI
2	207L00000X	Anesthesiology Physician	4301074733	MI

General Provider Information

NPI Number	:	1073698536
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER LEE WEDEVEN M.D.

Provider Business Mailing Address
First Line	:	2450 VAN OMMEN DR
Second Line	:
City	:	HOLLAND
State	:	MI
Zip	:	49424-8085
Country	:	US
Telephone Number	:	616-399-4946
Fax Number	:

Provider Business Practice Location Address
First Line	:	2450 VAN OMMEN DR
Second Line	:
City	:	HOLLAND
State	:	MI
Zip	:	49424-8085
Country	:	US
Telephone Number	:	616-399-4946
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	03/17/2011

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