MEDICARE: KAMAL KISHORE KASHYAP RPT

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	225100000X	Physical Therapist	5501005372	MI

General Provider Information

NPI Number	:	1861518508
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAMAL KISHORE KASHYAP RPT

Provider Business Mailing Address
First Line	:	3200 PRATT LAKE RD
Second Line	:
City	:	GLADWIN
State	:	MI
Zip	:	48624-8901
Country	:	US
Telephone Number	:	989-488-4569
Fax Number	:

Provider Business Practice Location Address
First Line	:	3200 PRATT LAKE RD
Second Line	:
City	:	GLADWIN
State	:	MI
Zip	:	48624-8901
Country	:	US
Telephone Number	:	989-488-4569
Fax Number	:

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

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	04/04/2014

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