Healthcare Provider Details

I. General information

NPI: 1659352888
Provider Name (Legal Business Name): LLOYD RICHARD KIEFT JR. ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/05/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5020 ASPEN DR
LANSING MI
48917-4030
US

IV. Provider business mailing address

5020 ASPEN DR
LANSING MI
48917-4030
US

V. Phone/Fax

Practice location:
  • Phone: 517-323-7747
  • Fax: 517-886-3803
Mailing address:
  • Phone: 517-323-7747
  • Fax: 517-886-3803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number800982
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: