Healthcare Provider Details

I. General information

NPI: 1821914904
Provider Name (Legal Business Name): LYDIA KAMBARI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6569 DUTTON TRAIL DR SE
CALEDONIA MI
49316-8393
US

IV. Provider business mailing address

6569 DUTTON TRAIL DR SE
CALEDONIA MI
49316-8393
US

V. Phone/Fax

Practice location:
  • Phone: 240-510-6994
  • Fax:
Mailing address:
  • Phone: 240-510-6994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License NumberM255564004934
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: