Healthcare Provider Details

I. General information

NPI: 1306543889
Provider Name (Legal Business Name): 4KAS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2023
Last Update Date: 02/22/2023
Certification Date: 02/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1428 KENILWORTH DR
LANSING MI
48917-2048
US

IV. Provider business mailing address

1428 KENILWORTH DR
LANSING MI
48917-2048
US

V. Phone/Fax

Practice location:
  • Phone: 517-803-0812
  • Fax:
Mailing address:
  • Phone: 517-803-0812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: MUHAMMAD KANG
Title or Position: AUTHORIZED OFFICIAL
Credential: DPM
Phone: 517-803-0812