Healthcare Provider Details

I. General information

NPI: 1548795974
Provider Name (Legal Business Name): MICHELE KLUNDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2017
Last Update Date: 04/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CHERRY ST SE
GRAND RAPIDS MI
49503-4526
US

IV. Provider business mailing address

859 146TH AVE
WAYLAND MI
49348-9784
US

V. Phone/Fax

Practice location:
  • Phone: 616-459-4314
  • Fax: 616-940-5340
Mailing address:
  • Phone: 616-635-8887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: