MEDICARE: DR. JEAN CHRISTIANA MARION TALSMA D.O.

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	207RA0401X	Addiction Medicine (Internal Medicine) Physician	5101020703	MI
2	207R00000X	Internal Medicine Physician	5101020703	MI

General Provider Information

NPI Number	:	1144660200
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEAN CHRISTIANA MARION TALSMA D.O.

Provider Business Mailing Address
First Line	:	4871 LUXEMBURG ST SE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49546-3747
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3584 FAIRLANES AVE SW
Second Line	:
City	:	GRANDVILLE
State	:	MI
Zip	:	49418-1583
Country	:	US
Telephone Number	:	844-866-2898
Fax Number	:

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

Provider Enumeration Date	:	07/03/2013
Last Update Date	:	08/23/2023

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