Healthcare Provider Details

I. General information

NPI: 1487825006
Provider Name (Legal Business Name): PROMED HEALTHCARE NURSE PRACTITIONERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2008
Last Update Date: 03/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5943 STADIUM DR STE 1
KALAMAZOO MI
49009-3016
US

IV. Provider business mailing address

5943 STADIUM DR STE 1
KALAMAZOO MI
49009-3016
US

V. Phone/Fax

Practice location:
  • Phone: 269-552-2836
  • Fax: 269-552-2964
Mailing address:
  • Phone: 269-552-2836
  • Fax: 269-552-2964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. ED MILLERMAIER
Title or Position: CHIEF MEDICAL OFFICER
Credential: M.D.
Phone: 269-552-2898