# PROMED HEALTHCARE NURSE PRACTITIONERS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1487825006
- **Authorized official:** DR. ED MILLERMAIER M.D. (CHIEF MEDICAL OFFICER)
- **Authorized official phone:** (269) 552-2898

## Contact information

- **Practice address:** 5943 STADIUM DR, STE 1, KALAMAZOO, MI 49009-3016
- **Practice address phone:** (269) 552-2836
- **Practice address fax:** (269) 552-2964
- **Mailing address:** 5943 STADIUM DR, STE 1, KALAMAZOO, MI 49009-3016
- **Mailing address phone:** (269) 552-2836
- **Mailing address fax:** (269) 552-2964

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | — | NULL | Yes |
| 363L00000X | Nurse Practitioner | — | — | Yes |
| 363LF0000X | Family Nurse Practitioner | — | NULL | — |
| 363LF0000X | Family Nurse Practitioner | — | — | — |
| 363LP0200X | Pediatric Nurse Practitioner | — | NULL | — |
| 363LP0200X | Pediatric Nurse Practitioner | — | — | — |
| 363LX0001X | Obstetrics & Gynecology Nurse Practitioner | — | NULL | — |
| 363LX0001X | Obstetrics & Gynecology Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 03/24/2008
- **Last updated:** 03/24/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0M92480 | MEDICARE GROUP \# | MI |