Provider Demographics
NPI:1801278429
Name:VEENSTRA, JESSE JAMES (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:JESSE
Middle Name:JAMES
Last Name:VEENSTRA
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Gender:M
Credentials:MD, PHD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3031 W GRAND BLVD STE 800
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-3141
Mailing Address - Country:US
Mailing Address - Phone:313-916-2151
Mailing Address - Fax:313-916-5334
Practice Address - Street 1:3031 W GRAND BLVD STE 800
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-3141
Practice Address - Country:US
Practice Address - Phone:313-916-2151
Practice Address - Fax:313-916-5334
Is Sole Proprietor?:No
Enumeration Date:2015-06-19
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301117358207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology