Healthcare Provider Details

I. General information

NPI: 1356744692
Provider Name (Legal Business Name): WMU SCHOOL OF MEDICINE CMDS CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2014
Last Update Date: 03/17/2025
Certification Date: 06/24/2021
Deactivation Date: 06/24/2021
Reactivation Date: 03/17/2025

III. Provider practice location address

1000 OAKLAND DR
KALAMAZOO MI
49008
US

IV. Provider business mailing address

1000 OAKLAND DR
KALAMAZOO MI
49008-1282
US

V. Phone/Fax

Practice location:
  • Phone: 269-337-6019
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LORI STRAUBE
Title or Position: ASSOCIATE DEAN FOR ADMIN & FINANCE
Credential:
Phone: 269-337-4508