Organization
KALAMAZOO ENDO CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JILL ANN ULBERG (ADMINISTRATOR)
(269) 321-3390
Entity
Organization
Contact information
Practice address
3300 COOLEY COURT, PORTAGE, MI 49024
(269) 321-3390
(269) 321-3392
Mailing address
3300 COOLEY CT, PORTAGE, MI 49024-7430
(269) 321-3390
(269) 321-3392
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
396833
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
23D1045430
CLIA CERTIFICATE WAIVER
—
01
—
396833
STATE LICENSE
MI
01
—
40006
BCBSMI
—
01
—
70733
AAAHC ORGANIZATION NUMBER
MI
Enumeration date
06/22/2006
Last updated
11/04/2025
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