Provider Demographics
NPI:1548481179
Name:PERRY, JILL MARJORIE (MD)
Entity type:Individual
Prefix:DR
First Name:JILL
Middle Name:MARJORIE
Last Name:PERRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JILL
Other - Middle Name:MARJORIE
Other - Last Name:ROLINSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:721 3 MILE RD NW STE 200
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49544-8224
Mailing Address - Country:US
Mailing Address - Phone:616-647-3777
Mailing Address - Fax:616-647-3788
Practice Address - Street 1:933 3 MILE RD NW
Practice Address - Street 2:SUITE 210
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49544-1673
Practice Address - Country:US
Practice Address - Phone:616-685-8150
Practice Address - Fax:616-785-0238
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301084056207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine