MEDICARE: JEANNE S. VEDDER M.D SC

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	207Y00000X	Otolaryngology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1000086	OTHER	WI	UNITED HEALTHCARE
2	1532113	OTHER	WI	UNITED MINE WORKERS
3	396608943E04	OTHER	WI	BLUE CROSS BLUE SHIELD
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740364132
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEANNE S. VEDDER M.D SC

Provider Business Mailing Address
First Line	:	1400-75 STREET
Second Line	:	SUITE 4
City	:	KENOSHA
State	:	WI
Zip	:	53143-1522
Country	:	US
Telephone Number	:	262-657-6577
Fax Number	:	262-657-7844

Provider Business Practice Location Address
First Line	:	1400-75 STREET
Second Line	:	SUITE 4
City	:	KENOSHA
State	:	WI
Zip	:	53143-1522
Country	:	US
Telephone Number	:	262-657-6577
Fax Number	:	262-657-7844

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JEANNE S. VEDDER
Credential	:	M.D.
Telephone Number	:	262-657-6577

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	10/11/2007

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