Provider Demographics
NPI:1033523980
Name:MAGERS, KAM (MAT/QIDP)
Entity Type:Individual
Prefix:
First Name:KAM
Middle Name:
Last Name:MAGERS
Suffix:
Gender:F
Credentials:MAT/QIDP
Other - Prefix:
Other - First Name:KERRY
Other - Middle Name:
Other - Last Name:MAGERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MAT/QIDP
Mailing Address - Street 1:3353 LOUSMA DR SE
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49548-2251
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3353 LOUSMA DR SE
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49548-2251
Practice Address - Country:US
Practice Address - Phone:616-443-4429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-19
Last Update Date:2014-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIIF0000000113773171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator