Healthcare Provider Details

I. General information

NPI: 1811948953
Provider Name (Legal Business Name): KASIM LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2006
Last Update Date: 12/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 3 MILE RD NW SUITE B
GRAND RAPIDS MI
49544-8251
US

IV. Provider business mailing address

1550 3 MILE RD NW SUITE B
GRAND RAPIDS MI
49544-8251
US

V. Phone/Fax

Practice location:
  • Phone: 616-785-8535
  • Fax: 616-785-1201
Mailing address:
  • Phone: 616-785-8535
  • Fax: 616-785-1201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. MICHELLE R BENT
Title or Position: BUSINESS MANAGER
Credential:
Phone: 616-785-8535