Individual
RILEY KIDD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
330 W MICHIGAN AVE, JACKSON, MI 49201-2121
(517) 787-7920
Mailing address
330 W MICHIGAN AVE, JACKSON, MI 49201-2121
(517) 787-7920
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
6801107678
MI
Other
Enumeration date
08/02/2021
Last updated
08/02/2021
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