MEDICARE: KINETIC HEALTH MANAGEMENT SOLUTIONS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies		MI

General Provider Information

NPI Number	:	1225137151
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KINETIC HEALTH MANAGEMENT SOLUTIONS, LLC

Provider Business Mailing Address
First Line	:	12001 CAMDEN ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48213-1754
Country	:	US
Telephone Number	:	313-839-3589
Fax Number	:	313-839-3589

Provider Business Practice Location Address
First Line	:	12001 CAMDEN ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48213-1754
Country	:	US
Telephone Number	:	313-839-3589
Fax Number	:	313-839-3589

Authorized Official
Title or Position	:	CEO
Name	:	MS. KHALIL T LIGON
Credential	:
Telephone Number	:	313-839-3589

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	02/13/2008

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