Healthcare Provider Details

I. General information

NPI: 1285540948
Provider Name (Legal Business Name): JOSHUA JAMES OUDING
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1608 LAKE ST
KALAMAZOO MI
49001-3170
US

IV. Provider business mailing address

1608 LAKE ST
KALAMAZOO MI
49001-3170
US

V. Phone/Fax

Practice location:
  • Phone: 226-532-0888
  • Fax:
Mailing address:
  • Phone: 226-532-0888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: