Healthcare Provider Details

I. General information

NPI: 1609307347
Provider Name (Legal Business Name): AERYN NAOMI KANGAS-DICK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2017
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N PARK ST
KALAMAZOO MI
49007-3731
US

IV. Provider business mailing address

200 N PARK ST
KALAMAZOO MI
49007-3731
US

V. Phone/Fax

Practice location:
  • Phone: 269-382-2500
  • Fax: 269-373-7478
Mailing address:
  • Phone: 269-382-2500
  • Fax: 269-373-7478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number4301514752
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: