Healthcare Provider Details

I. General information

NPI: 1407003965
Provider Name (Legal Business Name): KMC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2008
Last Update Date: 03/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24455 GODDARD RD
TAYLOR MI
48180-3933
US

IV. Provider business mailing address

24455 GODDARD RD
TAYLOR MI
48180-3933
US

V. Phone/Fax

Practice location:
  • Phone: 734-946-8186
  • Fax: 734-946-4849
Mailing address:
  • Phone: 734-946-8186
  • Fax: 734-946-4849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. KIMBERLY KNAPP
Title or Position: MANAGER
Credential:
Phone: 734-946-8186