Provider Demographics
NPI:1093056327
Name:HETLAND, KEVIN (CO)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:HETLAND
Suffix:
Gender:M
Credentials:CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2318 GULL RD STE A
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49048-3619
Mailing Address - Country:US
Mailing Address - Phone:269-345-1117
Mailing Address - Fax:
Practice Address - Street 1:2318 GULL RD STE A
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49048-3619
Practice Address - Country:US
Practice Address - Phone:269-345-1117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-12
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist