Provider Demographics
NPI:1710207535
Name:KUIPER, JEREMY JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:JAMES
Last Name:KUIPER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 MICHIGAN ST NE # MC845
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:616-486-6790
Mailing Address - Fax:
Practice Address - Street 1:230 W OAK ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:MI
Practice Address - Zip Code:49412-1526
Practice Address - Country:US
Practice Address - Phone:231-924-4200
Practice Address - Fax:616-267-9046
Is Sole Proprietor?:No
Enumeration Date:2010-06-03
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMT198007208600000X
MI4301099386208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery