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General NPI Number Information
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NPI Number | 1811933179
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Entity Type | Organization
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Legal Business Name | KALAMAZOO ENDO CENTER LLC
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Dates
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Enumeration Date | 06/22/2006
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Last Update Date | 11/04/2025
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Provider Practice Location Address
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Address Line | 3300 COOLEY COURT
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City | PORTAGE
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State | MI
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Zip | 49024
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Country | US
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Telephone | 269-321-3390
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Fax | 269-321-3392
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Provider Business Mailing Address
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Address Line | 3300 COOLEY CT
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City | PORTAGE
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State | MI
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Zip | 49024-7430
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Country | US
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Telephone | 269-321-3390
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Fax | 269-321-3392
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JILL ANN ULBERG
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Credential |
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Telephone | 269-321-3390
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 396833
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License Number State | MI
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