Individual
JENNIFER C CANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
221 MICHIGAN ST NE STE 600, GRAND RAPIDS, MI 49503
(616) 774-7035
Mailing address
100 MICHIGAN ST NE # MC845, GRAND RAPIDS, MI 49503-2560
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
5101020706
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
226756
—
AZ
Enumeration date
03/22/2013
Last updated
11/29/2018
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