Provider Demographics
NPI:1043219561
Name:POSTLEWAITE, JEFFREY D (DO)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:D
Last Name:POSTLEWAITE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5900 BYRON CENTER AVE SW
Mailing Address - Street 2:MEDICAL ADMINISTRATION
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49519-9606
Mailing Address - Country:US
Mailing Address - Phone:616-252-3243
Mailing Address - Fax:616-252-0260
Practice Address - Street 1:781 36TH ST SE
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49548-2319
Practice Address - Country:US
Practice Address - Phone:616-252-4100
Practice Address - Fax:616-252-4953
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2017-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101009306207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04522934OtherBLUE CROSS BLUE SHIELD GROUP NUMBER
IL036074396Medicaid
IL214979Medicare PIN
ILE43640Medicare UPIN
IL201737Medicare PIN
IL04522934OtherBLUE CROSS BLUE SHIELD GROUP NUMBER
IL036074396Medicaid
ILK40019Medicare PIN