Provider Demographics
NPI:1225137151
Name:KINETIC HEALTH MANAGEMENT SOLUTIONS, LLC
Entity Type:Organization
Organization Name:KINETIC HEALTH MANAGEMENT SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:KHALIL
Authorized Official - Middle Name:T
Authorized Official - Last Name:LIGON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-839-3589
Mailing Address - Street 1:12001 CAMDEN ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48213-1754
Mailing Address - Country:US
Mailing Address - Phone:313-839-3589
Mailing Address - Fax:313-839-3589
Practice Address - Street 1:12001 CAMDEN ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48213-1754
Practice Address - Country:US
Practice Address - Phone:313-839-3589
Practice Address - Fax:313-839-3589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies