Healthcare Provider Details

I. General information

NPI: 1437082237
Provider Name (Legal Business Name): MISS LILLIAN MAE KLOOSTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 S BURDICK ST
KALAMAZOO MI
49007-5221
US

IV. Provider business mailing address

5810 29TH ST S
SCOTTS MI
49088-8785
US

V. Phone/Fax

Practice location:
  • Phone: 269-373-6000
  • Fax:
Mailing address:
  • Phone: 269-217-6423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: