Healthcare Provider Details

I. General information

NPI: 1538187877
Provider Name (Legal Business Name): KAMAL PRADHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 12/17/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

358 E CHICAGO ST SUITE 202
COLDWATER MI
49036-2072
US

IV. Provider business mailing address

274 E CHICAGO ST
COLDWATER MI
49036-2041
US

V. Phone/Fax

Practice location:
  • Phone: 517-279-5252
  • Fax:
Mailing address:
  • Phone: 517-279-5400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301075578
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: