Healthcare Provider Details

I. General information

NPI: 1487728978
Provider Name (Legal Business Name): BRONSON PRACTICE MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 07/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 JOHN ST BOX 42
KALAMAZOO MI
49007-5341
US

IV. Provider business mailing address

601 JOHN ST BOX 42
KALAMAZOO MI
49007-5341
US

V. Phone/Fax

Practice location:
  • Phone: 269-341-7654
  • Fax: 269-341-8743
Mailing address:
  • Phone: 269-341-8419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: JAMES B FALAHEE JR.
Title or Position: SVP LEGAL AFFAIRS, C
Credential:
Phone: 269-341-6000