Healthcare Provider Details

I. General information

NPI: 1538137997
Provider Name (Legal Business Name): K VALLEY ORTHOPEDICS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 10/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 TURWILL LN
KALAMAZOO MI
49006-4231
US

IV. Provider business mailing address

315 TURWILL LN
KALAMAZOO MI
49006-4231
US

V. Phone/Fax

Practice location:
  • Phone: 269-343-8170
  • Fax: 269-382-2388
Mailing address:
  • Phone: 269-343-8170
  • Fax: 269-382-2388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. TIMOTHY W TENCATE
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 269-343-8170