Organization
PROMED HEALTHCARE NURSE PRACTITIONERS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ED MILLERMAIER M.D. (CHIEF MEDICAL OFFICER)
(269) 552-2898
Entity
Organization
Contact information
Practice address
5943 STADIUM DR, STE 1, KALAMAZOO, MI 49009-3016
(269) 552-2836
(269) 552-2964
Mailing address
5943 STADIUM DR, STE 1, KALAMAZOO, MI 49009-3016
(269) 552-2836
(269) 552-2964
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
—
—
363LF0000X
Family Nurse Practitioner
—
—
363LP0200X
Pediatric Nurse Practitioner
—
—
363LX0001X
Obstetrics & Gynecology Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0M92480
MEDICARE GROUP #
MI
Enumeration date
03/24/2008
Last updated
03/24/2008
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