Healthcare Provider Details

I. General information

NPI: 1124688197
Provider Name (Legal Business Name): LEEANN MARIE KUEHN PA-C, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2019
Last Update Date: 02/15/2023
Certification Date: 02/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 MIDTOWNE ST NE STE 301
GRAND RAPIDS MI
49503-5729
US

IV. Provider business mailing address

218 WARREN AVE SE
GRAND RAPIDS MI
49506-1582
US

V. Phone/Fax

Practice location:
  • Phone: 616-248-8864
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: