Provider Demographics
NPI:1083678767
Name:PARAGON HEALTH, PC
Entity Type:Organization
Organization Name:PARAGON HEALTH, PC
Other - Org Name:NEPHROLOGY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:C
Authorized Official - Last Name:RUMMEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:269-341-4554
Mailing Address - Street 1:521 E MICHIGAN AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-3889
Mailing Address - Country:US
Mailing Address - Phone:269-349-6759
Mailing Address - Fax:269-349-7450
Practice Address - Street 1:521 E MICHIGAN AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-3889
Practice Address - Country:US
Practice Address - Phone:269-349-6759
Practice Address - Fax:269-349-7450
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PARAGON HEALTH, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-12
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI110C910500OtherGROUP BCBS KALAMAZOO CNTY
MI7958131OtherAETNA GROUP ID
MI110A310340OtherGROUP BCBS CALHOUN CNTY
MI110A310340OtherGROUP BCBS CALHOUN CNTY
MI0M71430Medicare PIN