Provider Demographics
NPI:1891742631
Name:KAPENGA, JEANNE M (MD)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:M
Last Name:KAPENGA
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:3805 HEMMINGWAY DR
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-3836
Mailing Address - Country:US
Mailing Address - Phone:616-822-5509
Mailing Address - Fax:
Practice Address - Street 1:4129 OKEMOS RD STE 6
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-2821
Practice Address - Country:US
Practice Address - Phone:616-822-5509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301406814207L00000X, 2084A0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4823348-10Medicaid