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General NPI Number Information
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NPI Number | 1699279232
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Entity Type | Organization
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Legal Business Name | PERSONALIZED FAMILY PRACTICE, PLLC
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Dates
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Enumeration Date | 03/20/2018
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Last Update Date | 03/20/2018
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Provider Practice Location Address
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Address Line | 212 S MAIN ST FL 2
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City | BROOKLYN
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State | MI
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Zip | 49230-9114
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Country | US
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Telephone | 517-592-4847
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Fax | 517-938-8679
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Provider Business Mailing Address
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Address Line | 212 S MAIN ST FL 2
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City | BROOKLYN
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State | MI
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Zip | 49230-9114
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Country | US
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Telephone | 517-592-4847
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Fax | 517-938-8679
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GENE EMIL KIELHORN
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Credential | DO
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Telephone | 517-592-4847
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 5101007892
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License Number State | MI
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