Healthcare Provider Details

I. General information

NPI: 1578344933
Provider Name (Legal Business Name): CHARIS KAI ELEOS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2023
Last Update Date: 11/14/2023
Certification Date: 11/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2487 S MICHIGAN RD STE E
EATON RAPIDS MI
48827-8252
US

IV. Provider business mailing address

2487 S MICHIGAN RD STE E
EATON RAPIDS MI
48827-8252
US

V. Phone/Fax

Practice location:
  • Phone: 517-836-2178
  • Fax: 517-836-2182
Mailing address:
  • Phone: 517-836-2178
  • Fax: 517-836-2182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MS. PAMELA J BECKER
Title or Position: OWNER
Credential: FNP
Phone: 517-836-2178