Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | 4301042187 | MI |
NPI | 1891816427 |
---|---|
Provider Name | Mr. Lorenz P Kielhorn |
First Address | Kalamazoo, MI 49001-2748 |
Second Address | Kalamazoo, MI 49001-2748 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2007 |
Last Update Date | 14/10/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
LK042187 | BLUE CROSS BLUE SHIELD (01) | MI |