Provider Demographics
NPI:1114213154
Name:SEGEDY WHITE, JESSICA DEANNE (DO)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:DEANNE
Last Name:SEGEDY WHITE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:DEANNE
Other - Last Name:SEGEDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:6210 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-8925
Mailing Address - Country:US
Mailing Address - Phone:269-286-7030
Mailing Address - Fax:
Practice Address - Street 1:6210 W MAIN ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-8925
Practice Address - Country:US
Practice Address - Phone:269-286-7030
Practice Address - Fax:269-286-7031
Is Sole Proprietor?:No
Enumeration Date:2011-06-28
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101019470208000000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics