Provider Demographics
NPI:1114329554
Name:BATTLE CREEK FAMILY CARE
Entity Type:Organization
Organization Name:BATTLE CREEK FAMILY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:JEFFERY
Authorized Official - Last Name:KINZEL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:269-224-6190
Mailing Address - Street 1:2545 CAPITAL AVE SW STE 201
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49015-7103
Mailing Address - Country:US
Mailing Address - Phone:269-224-6190
Mailing Address - Fax:269-339-3044
Practice Address - Street 1:2545 CAPITAL AVE SW STE 201
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49015-7103
Practice Address - Country:US
Practice Address - Phone:269-224-6190
Practice Address - Fax:269-339-3044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-17
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP01470010Medicare UPIN