Individual
TEESHA LYNN BANCROFT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
329 S SAGE ST, KALAMAZOO, MI 49006
(269) 929-4079
Mailing address
7043 LEAWOOD ST, PORTAGE, MI 49024-4412
(269) 929-4079
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
7501005702
MI
Other
Enumeration date
01/26/2015
Last updated
01/26/2015
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