Individual
JILL MIEDEMA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
382 120TH AVE, HOLLAND, MI 49424-2169
(616) 396-6516
Mailing address
17581 DUNESIDE DR, GRAND HAVEN, MI 49417-8883
(517) 803-9493
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
51202
MN
Other
Enumeration date
04/07/2007
Last updated
07/30/2012
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