=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851590855
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMMUNITY AIDS RESOURCE AND EDUCATION SERVICES OF SOUTHWEST MICHIGAN
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/11/2007
-----------------------------------------------------
Last Update Date | 03/24/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 629 PIONEER ST
-----------------------------------------------------
City | KALAMAZOO
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49008-1860
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 269-381-2437
-----------------------------------------------------
Fax | 269-381-4050
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 629 PIONEER ST
-----------------------------------------------------
City | KALAMAZOO
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49008-1860
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 269-381-2437
-----------------------------------------------------
Fax | 269-381-4050
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MS. KELLY A DOYLE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 269-381-2437
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------