Active NPI
Jeanne Eyde, DO
- Plastic Surgery within the Head & Neck (Otolaryngology) Physician
- Wyoming, MI
National Provider Identifier
1851355655
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Plastic Surgery within the Head & Neck (Otolaryngology) Physician
- License
- JE013840
- Practice address
- 2215 44TH St SW
Suite 205
Wyoming, MI 49519-6439 - Phone
- (616) 252-8500
- NPI assigned
- Apr 17, 2006
- Last updated
- Sep 23, 2010
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Plastic Surgery within the Head & Neck (Otolaryngology) Physician | 207YX0007X | JE013840 | MI | Primary |
Addresses
Primary practice location
2215 44TH St SW
Suite 205
Wyoming, MI 49519-6439
Mailing address
1925 Breton Rd SE
Suite 201
Grand Rapids, MI 49506-4810
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851355655 | Medicaid | MI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| JE013840 | MI | MD | Plastic Surgery within the Head & Neck (Otolaryngology) Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1145232000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1285200000000",
"number": "1851355655",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1925 BRETON RD SE",
"address_2": "SUITE 201",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495064810"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2215 44TH ST SW",
"address_2": "SUITE 205",
"city": "WYOMING",
"state": "MI",
"postal_code": "495196439",
"telephone_number": "616-252-8500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EYDE",
"first_name": "JEANNE",
"name_prefix": "Dr.",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-04-17",
"last_updated": "2010-09-23",
"status": "A"
},
"taxonomies": [
{
"code": "207YX0007X",
"taxonomy_group": "",
"desc": "Otolaryngology, Plastic Surgery within the Head & Neck",
"state": "MI",
"license": "JE013840",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1851355655",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Wyoming, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.