Healthcare Provider Details

I. General information

NPI: 1811991771
Provider Name (Legal Business Name): GYL A. KASEWURM AUD, FAAA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 10/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 RENAISSANCE DR STE 100
SAINT JOSEPH MI
49085-2180
US

IV. Provider business mailing address

511 RENAISSANCE DR STE 100
SAINT JOSEPH MI
49085-2180
US

V. Phone/Fax

Practice location:
  • Phone: 269-982-3444
  • Fax: 269-982-3445
Mailing address:
  • Phone: 269-982-3444
  • Fax: 269-982-3445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number1601000002
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: