Provider Demographics
NPI:1790738193
Name:MEJEUR, RHONDA (MD)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:
Last Name:MEJEUR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 STATE ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-4328
Mailing Address - Country:US
Mailing Address - Phone:616-685-8050
Mailing Address - Fax:616-685-1850
Practice Address - Street 1:245 CHERRY ST SE
Practice Address - Street 2:STE 100
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-4607
Practice Address - Country:US
Practice Address - Phone:616-685-3200
Practice Address - Fax:616-458-3526
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2012-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301068483207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4345992Medicaid
MI4895946Medicaid
MI4346013Medicaid
MI4346022Medicaid
MI4339242Medicaid
MI4328599Medicaid
MI4330640Medicaid
MI4895946Medicaid
MI4330640Medicaid
MIP32930111Medicare ID - Type Unspecified
MI4346022Medicaid