Healthcare Provider Details

I. General information

NPI: 1518928035
Provider Name (Legal Business Name): KIDNEY CENTERS OF MICHIGAN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2006
Last Update Date: 01/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13481 W 10 MILE RD
OAK PARK MI
48237-4633
US

IV. Provider business mailing address

5200 VIRGINIA WAY L&C DEPT
BRENTWOOD TN
37027-7569
US

V. Phone/Fax

Practice location:
  • Phone: 248-582-9750
  • Fax: 248-582-9760
Mailing address:
  • Phone: 615-320-4214
  • Fax: 877-735-8016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JAMES K HILGER
Title or Position: CHIEF ACCOUNTING OFFICER
Credential:
Phone: 253-733-4500