Individual
KIPP L CHILLAG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1675 LEAHY ST STE 401A, MUSKEGON, MI 49442-5547
(231) 672-4243
(231) 727-4214
Mailing address
PO BOX 1848, MUSKEGON, MI 49443-1848
(231) 672-4243
(231) 727-4214
Taxonomy
Speciality
Code
Description
License number
State
2080P0008X
Pediatric Neurodevelopmental Disabilities Physician
51010114017
MI
2084N0400X
Neurology Physician
Primary
5101014017
MI
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
5101014017
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
H400493386
MEDICARE PTAN
MN
Enumeration date
02/17/2006
Last updated
09/13/2021
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