Healthcare Provider Details

I. General information

NPI: 1972857720
Provider Name (Legal Business Name): MICHAEL KUIK BA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2012
Last Update Date: 11/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 WEST GREEN STREET
HASTINGS MI
49058-1723
US

IV. Provider business mailing address

915 WEST GREEN STREET
HASTINGS MI
49058-1723
US

V. Phone/Fax

Practice location:
  • Phone: 269-948-8041
  • Fax: 269-948-9319
Mailing address:
  • Phone: 269-948-8041
  • Fax: 269-948-9319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: