Healthcare Provider Details

I. General information

NPI: 1851590855
Provider Name (Legal Business Name): COMMUNITY AIDS RESOURCE AND EDUCATION SERVICES OF SOUTHWEST MICHIGAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2007
Last Update Date: 03/24/2023
Certification Date: 03/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

629 PIONEER ST
KALAMAZOO MI
49008-1860
US

IV. Provider business mailing address

629 PIONEER ST
KALAMAZOO MI
49008-1860
US

V. Phone/Fax

Practice location:
  • Phone: 269-381-2437
  • Fax: 269-381-4050
Mailing address:
  • Phone: 269-381-2437
  • Fax: 269-381-4050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. KELLY A DOYLE
Title or Position: CEO
Credential:
Phone: 269-381-2437