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NPI Code Detail

MEDICARE: KIMBERLY TEW PA

MEDICARE: KIMBERLY TEW PA
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
1363A00000XPhysician Assistant5601003450MI

General Provider Information

NPI Number : 1902990583
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIMBERLY TEW PA
Provider Business Mailing Address
First Line : 100 MICHIGAN ST NE
Second Line : MC 845
City : GRAND RAPIDS
State : MI
Zip : 49503-2560
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 25 CONRAN DR
Second Line : SUITE B
City : COOPERSVILLE
State : MI
Zip : 49404-1366
Country : US
Telephone Number : 616-267-7860
Fax Number : 616-267-7861
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/03/2006
Last Update Date : 03/03/2021

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Directions to “ KIMBERLY TEW PA” Practice Location

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