Healthcare Provider Details

I. General information

NPI: 1023079530
Provider Name (Legal Business Name): KIDNEY CENTERS OF MICHIGAN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2006
Last Update Date: 12/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28295 SCHOENHERR RD STE A
WARREN MI
48088-4300
US

IV. Provider business mailing address

5200 VIRGINIA WAY L&C DEPT
BRENTWOOD TN
37027-7569
US

V. Phone/Fax

Practice location:
  • Phone: 586-558-8160
  • Fax: 586-558-8159
Mailing address:
  • Phone: 800-467-4736
  • Fax: 615-320-4487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JAMES K HILGER
Title or Position: CHIEF ACCOUNTING OFFICER
Credential:
Phone: 253-733-4500