Provider Demographics
NPI:1316334253
Name:KEPES, JEFFREY A (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:A
Last Name:KEPES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:317 S ELM ST STE 205A
Mailing Address - Street 2:
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867-2636
Mailing Address - Country:US
Mailing Address - Phone:989-729-4317
Mailing Address - Fax:989-725-9979
Practice Address - Street 1:317 S ELM ST STE 205A
Practice Address - Street 2:
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-2636
Practice Address - Country:US
Practice Address - Phone:989-729-4317
Practice Address - Fax:989-725-9979
Is Sole Proprietor?:No
Enumeration Date:2015-04-17
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43015013092080P0201X, 207K00000X
WI3768-320207K00000X
NDPT18107207K00000X
OH35.143726207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No2080P0201XAllopathic & Osteopathic PhysiciansPediatricsPediatric Allergy/Immunology
No207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1316334253Medicaid