Healthcare Provider Details

I. General information

NPI: 1881853901
Provider Name (Legal Business Name): WESTERN MICHIGAN UNIVERSITY UNIFIED CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2008
Last Update Date: 06/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 OAKLAND DR FL 3
KALAMAZOO MI
49008-1282
US

IV. Provider business mailing address

1000 OAKLAND DR FL 3
KALAMAZOO MI
49008-1282
US

V. Phone/Fax

Practice location:
  • Phone: 269-387-8047
  • Fax: 269-387-7026
Mailing address:
  • Phone: 269-387-8047
  • Fax: 269-387-7026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. CAROL SUNDBERG
Title or Position: DIRECTOR
Credential: PH.D.
Phone: 269-387-7005