Healthcare Provider Details

I. General information

NPI: 1952127847
Provider Name (Legal Business Name): KIRSTEN KAMAHA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2024
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5333 MCAULEY DR RM 4003
YPSILANTI MI
48197-1099
US

IV. Provider business mailing address

5333 MCAULEY DR RM 4003
YPSILANTI MI
48197-1099
US

V. Phone/Fax

Practice location:
  • Phone: 734-715-1706
  • Fax: 734-869-1212
Mailing address:
  • Phone: 734-715-1706
  • Fax: 734-869-1212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601013188
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: