Healthcare Provider Details

I. General information

NPI: 1083231849
Provider Name (Legal Business Name): KALEIGH NORMA MENDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2020
Last Update Date: 05/24/2022
Certification Date: 05/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 N MONROE ST
MONROE MI
48162-3113
US

IV. Provider business mailing address

3658 RANCHERO DR
ANN ARBOR MI
48108-5200
US

V. Phone/Fax

Practice location:
  • Phone: 734-682-3309
  • Fax:
Mailing address:
  • Phone: 315-657-3342
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601010029
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: