Organization
MATERNAL INFANT HEALTH PROGRAM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MOSES L WALKER (INTERIM CEO/PRESIDENT)
(269) 349-2641
Entity
Organization
Contact information
Practice address
117 W PATERSON ST, KALAMAZOO, MI 49007-2557
(269) 349-2641
Mailing address
117 W PATERSON ST, KALAMAZOO, MI 49007-2557
(269) 349-2641
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
430063404
MI
171M00000X
Case Manager/Care Coordinator
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4784295
—
MI
Enumeration date
09/27/2007
Last updated
09/13/2017
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