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General NPI Number Information
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NPI Number | 1073885695
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Entity Type | Organization
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Legal Business Name | EPMG DOWNRIVER, PLLC (NURSE PRACTITIONERS)
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Dates
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Enumeration Date | 01/27/2012
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Last Update Date | 09/12/2019
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Provider Practice Location Address
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Address Line | 2333 BIDDLE AVE
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City | WYANDOTTE
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State | MI
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Zip | 48192-4668
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Country | US
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Telephone | 734-246-6000
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Fax | 734-995-2913
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Provider Business Mailing Address
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Address Line | 2000 GREEN RD SUITE 300
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City | ANN ARBOR
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State | MI
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Zip | 48105-1598
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Country | US
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Telephone | 954-838-2371
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Fax | 734-995-2913
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Authorized Official
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Title or Position | OFFICER
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Name | KATHLEEN KONDAS
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Credential |
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Telephone | 954-838-2371
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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