Healthcare Provider Details

I. General information

NPI: 1881884039
Provider Name (Legal Business Name): JUDY S KAMMER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2007
Last Update Date: 07/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 SPRING ARBOR RD
JACKSON MI
49203-3895
US

IV. Provider business mailing address

PO BOX 635477
CINCINNATI OH
45263-0001
US

V. Phone/Fax

Practice location:
  • Phone: 517-768-0600
  • Fax: 517-768-0606
Mailing address:
  • Phone: 517-768-0600
  • Fax: 517-768-0606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601002577
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: