Healthcare Provider Details

I. General information

NPI: 1124092838
Provider Name (Legal Business Name): LISABETH JOY GEE P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISABETH JOY KUNST

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 01/19/2021
Certification Date: 01/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 N MAPLE ST
GRANT MI
49327
US

IV. Provider business mailing address

520 COBB ST
CADILLAC MI
49601-2588
US

V. Phone/Fax

Practice location:
  • Phone: 231-834-0444
  • Fax: 231-834-0200
Mailing address:
  • Phone: 231-876-6527
  • Fax: 231-876-6519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601003832
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: