Individual
JEMELLEE PERPETUA JACALA-TADIAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
13320 N BLVD, VICKSBURG, MI 49097-1514
(269) 649-2012
Mailing address
601 JOHN ST, KALAMAZOO, MI 49007-5341
(989) 742-2183
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4301088607
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1669681748
—
MI
Enumeration date
05/22/2007
Last updated
10/01/2024
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