Provider Demographics
NPI:1992142624
Name:VEENEMA, JEREMY ROBERT (DO)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:ROBERT
Last Name:VEENEMA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2125 NEGAUNEE DR SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-5318
Mailing Address - Country:US
Mailing Address - Phone:616-443-6958
Mailing Address - Fax:
Practice Address - Street 1:710 KENMOOR AVE SE
Practice Address - Street 2:SUITE 110
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-2379
Practice Address - Country:US
Practice Address - Phone:616-949-6112
Practice Address - Fax:616-949-8530
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-04
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125062773208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics