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General NPI Number Information
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NPI Number | 1609349802
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Entity Type | Individual
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Provider Name | KIMBERLY MARIE COMEAU PA-C
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Gender | Female
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Dates
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Enumeration Date | 01/10/2019
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 616 MEIJER DR
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City | CHARLOTTE
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State | MI
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Zip | 48813-8457
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Country | US
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Telephone | 517-541-5935
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Fax |
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Provider Business Mailing Address
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Address Line | 4100 EMBASSY DR SE STE 400
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-2416
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Country | US
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Telephone | 616-975-1845
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5601008964
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License Number State | MI
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