=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356744692
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WMU SCHOOL OF MEDICINE CMDS CLINIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/01/2014
-----------------------------------------------------
Last Update Date | 03/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1000 OAKLAND DR
-----------------------------------------------------
City | KALAMAZOO
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49008
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 269-337-6019
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1000 OAKLAND DR
-----------------------------------------------------
City | KALAMAZOO
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49008-1282
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ASSOCIATE DEAN FOR ADMIN & FINANCE
-----------------------------------------------------
Name | LORI STRAUBE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 269-337-4508
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM1300X
-----------------------------------------------------
Taxonomy Name | Multi-Specialty Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------