Healthcare Provider Details

I. General information

NPI: 1457388449
Provider Name (Legal Business Name): KURT P HELGERSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 11/27/2023
Certification Date: 10/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8906 M 89
RICHLAND MI
49083
US

IV. Provider business mailing address

6268 E.AB AVE.
RICHLAND MI
49083-9521
US

V. Phone/Fax

Practice location:
  • Phone: 269-286-7130
  • Fax: 269-286-7131
Mailing address:
  • Phone: 269-629-5001
  • Fax: 269-629-7137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301406802
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: