Provider Demographics
NPI:1538168752
Name:VEDDER, JEANNE SUE (MD)
Entity type:Individual
Prefix:DR
First Name:JEANNE
Middle Name:SUE
Last Name:VEDDER
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1400-75 TH STREET
Mailing Address - Street 2:SUITE 4
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53143-1522
Mailing Address - Country:US
Mailing Address - Phone:262-657-6577
Mailing Address - Fax:262-657-7844
Practice Address - Street 1:1400-75 TH STREET
Practice Address - Street 2:SUITE 4
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53143-1522
Practice Address - Country:US
Practice Address - Phone:262-657-6577
Practice Address - Fax:262-657-7844
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2007-10-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI25045207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIE09572Medicare UPIN