Organization
JEANNE S. VEDDER M.D SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEANNE S. VEDDER M.D. (PRESIDENT)
(262) 657-6577
Entity
Organization
Contact information
Practice address
1400-75 STREET, SUITE 4, KENOSHA, WI 53143-1522
(262) 657-6577
(262) 657-7844
Mailing address
1400-75 STREET, SUITE 4, KENOSHA, WI 53143-1522
(262) 657-6577
(262) 657-7844
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1000086
UNITED HEALTHCARE
WI
01
—
1532113
UNITED MINE WORKERS
WI
05
—
31564000
—
WI
01
—
396608943E04
BLUE CROSS BLUE SHIELD
WI
Enumeration date
10/24/2006
Last updated
10/11/2007
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