Individual
JENNIFER J EKKENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
200 JEFFERSON AVE SE, GRAND RAPIDS, MI 49503-4502
(800) 968-6866
Mailing address
PO BOX Q, GRAND RAPIDS, MI 49501-4917
(800) 968-6866
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
5101015656
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1598712390
GROUP NPI
MI
05
—
4827374
—
MI
05
—
4827383
—
MI
05
—
4827392
—
MI
05
—
4827409
—
MI
05
—
4827418
—
MI
05
—
5201638
—
MI
01
—
JE015656
BCBS
MI
01
—
P00415675
RAILROAD MEDICARE
MI
Enumeration date
05/03/2006
Last updated
01/23/2008
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