Individual
MR. KIM MICHAEL SCHRADER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
1256 WALKER AVE NW, GRAND RAPIDS, MI 49504-4067
(616) 774-8789
(616) 774-0799
Mailing address
1256 WALKER AVE NW, GRAND RAPIDS, MI 49504-4067
(616) 774-8789
(616) 774-0799
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703041028
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4703041028
LPN LICENSE
MI
Enumeration date
03/23/2007
Last updated
07/08/2007
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