Provider Demographics
NPI:1043734502
Name:KIMFON, CAJETAN
Entity Type:Individual
Prefix:MR
First Name:CAJETAN
Middle Name:
Last Name:KIMFON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8258 HONEYTREE BLVD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-4111
Mailing Address - Country:US
Mailing Address - Phone:313-960-0934
Mailing Address - Fax:
Practice Address - Street 1:8258 HONEYTREE BLVD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-4111
Practice Address - Country:US
Practice Address - Phone:313-960-0934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704284906163WH0200X
251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No163WH0200XNursing Service ProvidersRegistered NurseHome Health