Individual
JOHN E JEPSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
2120 43RD ST SE, SUITE 100, GRAND RAPIDS, MI 49508-3772
(616) 281-1144
(616) 281-1221
Mailing address
7126 RIVER GLEN DR SE, CALEDONIA, MI 49316-8135
(616) 891-7916
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5501005526
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0D15758
BCBSMI PROVIDER NUMBER
MI
Enumeration date
04/13/2007
Last updated
07/08/2007
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