Provider Demographics
NPI:1407003965
Name:KMC INC
Entity Type:Organization
Organization Name:KMC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:KNAPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-946-8186
Mailing Address - Street 1:24455 GODDARD RD
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-3933
Mailing Address - Country:US
Mailing Address - Phone:734-946-8186
Mailing Address - Fax:734-946-4849
Practice Address - Street 1:24455 GODDARD RD
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-3933
Practice Address - Country:US
Practice Address - Phone:734-946-8186
Practice Address - Fax:734-946-4849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-26
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI110H240910OtherBCBSM PIN
MI1158218090OtherBCBSM
MIDK002533OtherBCBSM LICENSE
MI1158218090OtherBCBSM