Healthcare Provider Details

I. General information

NPI: 1659635647
Provider Name (Legal Business Name): PAUL MICHAEL KIGER LMSW, CAADC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2012
Last Update Date: 12/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

359 DIVISION AVE S
GRAND RAPIDS MI
49503-4537
US

IV. Provider business mailing address

103 ROSEMARY ST SE
GRAND RAPIDS MI
49507-3449
US

V. Phone/Fax

Practice location:
  • Phone: 616-685-3800
  • Fax:
Mailing address:
  • Phone: 616-430-6267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6801094439
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: