Healthcare Provider Details

I. General information

NPI: 1316362932
Provider Name (Legal Business Name): KEITH LOHMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2014
Last Update Date: 02/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6276 N RIVERVIEW DR
KALAMAZOO MI
49004-9601
US

IV. Provider business mailing address

5424 KEYES DR
KALAMAZOO MI
49004-1529
US

V. Phone/Fax

Practice location:
  • Phone: 269-382-3840
  • Fax: 269-382-3840
Mailing address:
  • Phone: 269-382-3840
  • Fax: 269-382-3840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: