Individual
DR. TIMOTHY RUSSEL JELSEMA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
705 OAK ST UNIT 11, BIG RAPIDS, MI 49307-3108
(231) 592-1002
Mailing address
100 MICHIGAN ST NE # MC845, GRAND RAPIDS, MI 49503-2560
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
4301110558
MI
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
4301110558
MI
Other
Enumeration date
06/27/2016
Last updated
02/17/2021
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