Individual
MRS. KEATON BUMGARDNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3111 ELECTRIC AVE, PORT HURON, MI 48060-8127
(810) 985-8900
Mailing address
3499 METCALF RD, FORT GRATIOT, MI 48059-2567
(810) 300-9598
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
6802088261
MI
Other
Enumeration date
11/07/2014
Last updated
11/07/2014
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