MEDICARE: KEVIN MUNSON LMSW

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	104100000X	Social Worker	6801104298	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6801104298	OTHER	MI	LARA MICHIGAN

General Provider Information

NPI Number	:	1366815466
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN MUNSON LMSW

Provider Business Mailing Address
First Line	:	7100 STADIUM DR
Second Line	:
City	:	KALAMAZOO
State	:	MI
Zip	:	49009-9423
Country	:	US
Telephone Number	:	269-345-0273
Fax Number	:	269-345-8522

Provider Business Practice Location Address
First Line	:	7100 STADIUM DR
Second Line	:
City	:	KALAMAZOO
State	:	MI
Zip	:	49009-9423
Country	:	US
Telephone Number	:	269-345-0273
Fax Number	:	269-345-8522

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/11/2015
Last Update Date	:	01/11/2024

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