Healthcare Provider Details

I. General information

NPI: 1619112620
Provider Name (Legal Business Name): MCDONALD & KIMBALL PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2008
Last Update Date: 12/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 N RIVER ST
FENTON MI
48430-3800
US

IV. Provider business mailing address

129 N RIVER ST
FENTON MI
48430-3800
US

V. Phone/Fax

Practice location:
  • Phone: 810-629-0760
  • Fax: 810-616-6268
Mailing address:
  • Phone: 810-629-0760
  • Fax: 810-616-6268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateMI

VIII. Authorized Official

Name: MR. WILLIAM K MCDONALD
Title or Position: PARTNER & AUTHORIZED AGENT
Credential: M.DIV., LMSW
Phone: 810-629-0760