Healthcare Provider Details

I. General information

NPI: 1780980870
Provider Name (Legal Business Name): KJM PROPERTIES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2011
Last Update Date: 02/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 1ST ST
STEVENS POINT WI
54481-2631
US

IV. Provider business mailing address

2225 EAGLE SMT
STEVENS POINT WI
54482-8977
US

V. Phone/Fax

Practice location:
  • Phone: 715-343-8848
  • Fax:
Mailing address:
  • Phone: 715-343-8848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State

VIII. Authorized Official

Name: MRS. KRISTA MENDYKE
Title or Position: OWNER
Credential:
Phone: 715-343-8848