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General NPI Number Information
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NPI Number | 1407003965
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Entity Type | Organization
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Legal Business Name | KMC INC
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Dates
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Enumeration Date | 08/26/2008
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Last Update Date | 03/09/2009
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Provider Practice Location Address
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Address Line | 24455 GODDARD RD
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City | TAYLOR
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State | MI
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Zip | 48180-3933
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Country | US
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Telephone | 734-946-8186
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Fax | 734-946-4849
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Provider Business Mailing Address
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Address Line | 24455 GODDARD RD
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City | TAYLOR
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State | MI
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Zip | 48180-3933
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Country | US
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Telephone | 734-946-8186
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Fax | 734-946-4849
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Authorized Official
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Title or Position | MANAGER
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Name | MRS. KIMBERLY KNAPP
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Credential |
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Telephone | 734-946-8186
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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