Provider Demographics
NPI:1225008782
Name:VENEMA, WILLIAM J (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:J
Last Name:VENEMA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:601 JOHN ST
Mailing Address - Street 2:BOX 42
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-5341
Mailing Address - Country:US
Mailing Address - Phone:269-341-7806
Mailing Address - Fax:269-341-8743
Practice Address - Street 1:5629 STADIUM DR
Practice Address - Street 2:BRONSON RAMBLING ROAD PEDIATRICS
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-1952
Practice Address - Country:US
Practice Address - Phone:269-371-1000
Practice Address - Fax:269-372-0698
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2007-11-07
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Provider Licenses
StateLicense IDTaxonomies
MI4301025837208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4467331Medicaid
MI4467331Medicaid