Healthcare Provider Details

I. General information

NPI: 1356338958
Provider Name (Legal Business Name): KAYLYNN DECARLI D.O
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 08/31/2021
Certification Date: 08/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 S US HIGHWAY 131
THREE RIVERS MI
49093-8831
US

IV. Provider business mailing address

601 JOHN STREET BOX 39
KALAMAZOO MI
49007
US

V. Phone/Fax

Practice location:
  • Phone: 269-286-7070
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QB0002X
TaxonomyObesity Medicine (Family Medicine) Physician
License Number5101015461
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101015461
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: