MEDICARE: KAMAL KAUR

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	363LF0000X	Family Nurse Practitioner	4704325246	MI

General Provider Information

NPI Number	:	1619648508
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAMAL KAUR

Provider Business Mailing Address
First Line	:	9036 E MI STATE ROAD 36
Second Line	:
City	:	WHITMORE LAKE
State	:	MI
Zip	:	48189-8147
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9036 E MI STATE ROAD 36
Second Line	:
City	:	WHITMORE LAKE
State	:	MI
Zip	:	48189-8147
Country	:	US
Telephone Number	:	734-449-3320
Fax Number	:

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

Provider Enumeration Date	:	09/21/2021
Last Update Date	:	04/28/2023

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