1356302848 NPI number — KIDNEY CENTERS OF MICHIGAN LLC

Table of content: JILL MARIE KLESSIG MD (NPI 1790705150)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356302848 NPI number — KIDNEY CENTERS OF MICHIGAN LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KIDNEY CENTERS OF MICHIGAN LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356302848
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/19/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5200 VIRGINIA WAY
Provider Second Line Business Mailing Address:
L&C DEPT
Provider Business Mailing Address City Name:
BRENTWOOD
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37027-7569
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-467-4736
Provider Business Mailing Address Fax Number:
615-320-4487

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7960 GRAND RIVER RD
Provider Second Line Business Practice Location Address:
STE 210
Provider Business Practice Location Address City Name:
BRIGHTON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48114-7336
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-225-6288
Provider Business Practice Location Address Fax Number:
810-225-6291
Provider Enumeration Date:
04/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HILGER
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
K
Authorized Official Title or Position:
CHIEF ACCOUNTING OFFICER
Authorized Official Telephone Number:
253-733-4500

Provider Taxonomy Codes

  • Taxonomy code: 261QE0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4562199 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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