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General NPI Number Information
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NPI Number | 1497812002
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Entity Type | Organization
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Legal Business Name | KALAMAZOO SHOE COMPANY, INC.
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Dates
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Enumeration Date | 01/02/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1016 E CORK ST
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City | KALAMAZOO
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State | MI
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Zip | 49001-4823
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Country | US
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Telephone | 269-349-2247
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Fax | 269-349-0529
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Provider Business Mailing Address
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Address Line | 1016 E CORK ST
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City | KALAMAZOO
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State | MI
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Zip | 49001-4823
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Country | US
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Telephone | 269-349-2247
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Fax | 269-349-0529
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JEFF DAVIS
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Credential | C. PED
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Telephone | 269-349-2247
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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