Healthcare Provider Details

I. General information

NPI: 1326181801
Provider Name (Legal Business Name): SCOTT DOUGLAS MICHEL M.A., A.T.C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 ACADEMY ST KALAMAZOO COLLEGE
KALAMAZOO MI
49006-3268
US

IV. Provider business mailing address

1522 VASSAR DR
KALAMAZOO MI
49001-4440
US

V. Phone/Fax

Practice location:
  • Phone: 269-337-7093
  • Fax: 269-337-7401
Mailing address:
  • Phone: 269-226-9099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: