Organization
KMI TECHNOLOGIES, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHARLES DECOSTER (COO)
(435) 680-9782
Entity
Organization
Contact information
Practice address
2815 MICHIGAN ST NE STE D, GRAND RAPIDS, MI 49506-1266
(435) 680-9782
Mailing address
2815 MICHIGAN ST NE STE D, GRAND RAPIDS, MI 49506-1266
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
—
—
163WP0808X
Psychiatric/Mental Health Registered Nurse
—
—
207QA0505X
Adult Medicine Physician
—
—
2084P0800X
Psychiatry Physician
—
—
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
Other
Enumeration date
08/05/2025
Last updated
08/26/2025
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