Healthcare Provider Details

I. General information

NPI: 1780176776
Provider Name (Legal Business Name): BADRINA KUHL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2018
Last Update Date: 06/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N WEST AVE
JACKSON MI
49202-2179
US

IV. Provider business mailing address

854 N BROWN ST
JACKSON MI
49202-3004
US

V. Phone/Fax

Practice location:
  • Phone: 517-789-2494
  • Fax:
Mailing address:
  • Phone: 248-535-9860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number6802089283
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: