Basic Information
| Provider Information | |||||||||
| NPI: | 1255447769 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DURANCEAU | ||||||||
| FirstName: | JESSE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5943 STADIUM DR | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | KALAMAZOO | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490093016 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 7895 CURRIER DR | ||||||||
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| City: | PORTAGE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490024314 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2693217120 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 5101012305 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.