Provider Demographics
NPI:1982820023
Name:EDELMAN, JESSA KRISTEN (MD)
Entity Type:Individual
Prefix:DR
First Name:JESSA
Middle Name:KRISTEN
Last Name:EDELMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JESSA
Other - Middle Name:KRISTEN
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5768 HAMPSHIRE LN
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-3201
Mailing Address - Country:US
Mailing Address - Phone:248-330-2802
Mailing Address - Fax:
Practice Address - Street 1:5333 MCCAULEY DRIVE
Practice Address - Street 2:SUITE 3009
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48106
Practice Address - Country:US
Practice Address - Phone:734-712-3935
Practice Address - Fax:734-712-5583
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301083962207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine