Provider Demographics
NPI:1568403756
Name:MACAL, KIMBERLY ANN (RD, CDE)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:ANN
Last Name:MACAL
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:300 HEALTH PARK DRIVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867-1292
Mailing Address - Country:US
Mailing Address - Phone:989-723-5540
Mailing Address - Fax:
Practice Address - Street 1:300 HEALTH PARK DRIVE
Practice Address - Street 2:SUITE 302
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-1292
Practice Address - Country:US
Practice Address - Phone:989-723-5540
Practice Address - Fax:989-720-2292
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP66019Medicare UPIN