Healthcare Provider Details

I. General information

NPI: 1093638561
Provider Name (Legal Business Name): ELI KOESTER
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 W MICHIGAN AVE STE 204
SALINE MI
48176-1329
US

IV. Provider business mailing address

13231 S ELDER AVE
GRANT MI
49327-9651
US

V. Phone/Fax

Practice location:
  • Phone: 734-489-1923
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: