MEDICARE: MRS. KIMBERLY KAY DANIELS BHUS, DP-C

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	101YA0400X	Addiction (Substance Use Disorder) Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689137903
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KIMBERLY KAY DANIELS BHUS, DP-C

Provider Business Mailing Address
First Line	:	1480 N M 52 STE A
Second Line	:
City	:	OWOSSO
State	:	MI
Zip	:	48867-1290
Country	:	US
Telephone Number	:	989-723-8239
Fax Number	:	989-723-8230

Provider Business Practice Location Address
First Line	:	1480 N M 52 STE A
Second Line	:
City	:	OWOSSO
State	:	MI
Zip	:	48867-1290
Country	:	US
Telephone Number	:	989-723-8239
Fax Number	:	989-723-8230

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

Provider Enumeration Date	:	04/12/2019
Last Update Date	:	03/03/2022

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Directions to “ MRS. KIMBERLY KAY DANIELS BHUS, DP-C” Practice Location

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