Provider Demographics
NPI:1811384308
Name:ACCESS HOUSECALL
Entity Type:Organization
Organization Name:ACCESS HOUSECALL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FAJARDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:888-587-9444
Mailing Address - Street 1:3408 MILLER RD
Mailing Address - Street 2:STE 369
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49001-4111
Mailing Address - Country:US
Mailing Address - Phone:888-587-9444
Mailing Address - Fax:888-541-5546
Practice Address - Street 1:3408 MILLER RD
Practice Address - Street 2:STE 369
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49001-4111
Practice Address - Country:US
Practice Address - Phone:888-587-9444
Practice Address - Fax:888-541-5546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-22
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704277414363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty