Healthcare Provider Details

I. General information

NPI: 1164950887
Provider Name (Legal Business Name): PETER WILLIAM KUHL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2017
Last Update Date: 04/22/2024
Certification Date: 04/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 LAURENCE AVE STE E
JACKSON MI
49202-2980
US

IV. Provider business mailing address

1001 LAURENCE AVE STE E
JACKSON MI
49202-2980
US

V. Phone/Fax

Practice location:
  • Phone: 517-750-4777
  • Fax: 517-782-4717
Mailing address:
  • Phone: 517-782-3717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801116633
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: