Provider Demographics
NPI:1922290964
Name:ESSARY, COLLEEN JUNE (DO)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:JUNE
Last Name:ESSARY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:JUNE
Other - Last Name:VELLEMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:10359 OLD HIGHWAY 54
Mailing Address - Street 2:
Mailing Address - City:NEW BLOOMFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65063
Mailing Address - Country:US
Mailing Address - Phone:573-632-5582
Mailing Address - Fax:573-632-5875
Practice Address - Street 1:829 N CENTER AVE STE 210
Practice Address - Street 2:
Practice Address - City:GAYLORD
Practice Address - State:MI
Practice Address - Zip Code:49735-1599
Practice Address - Country:US
Practice Address - Phone:989-731-7860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101008393207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine