Healthcare Provider Details

I. General information

NPI: 1497812002
Provider Name (Legal Business Name): KALAMAZOO SHOE COMPANY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1016 E CORK ST
KALAMAZOO MI
49001-4823
US

IV. Provider business mailing address

1016 E CORK ST
KALAMAZOO MI
49001-4823
US

V. Phone/Fax

Practice location:
  • Phone: 269-349-2247
  • Fax: 269-349-0529
Mailing address:
  • Phone: 269-349-2247
  • Fax: 269-349-0529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. JEFF DAVIS
Title or Position: PRESIDENT
Credential: C. PED
Phone: 269-349-2247