Provider Demographics
NPI:1821412784
Name:MACEY, KIM (LMT)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:MACEY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2455 CHILSON MEADOWS LN
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-9483
Mailing Address - Country:US
Mailing Address - Phone:810-599-0196
Mailing Address - Fax:
Practice Address - Street 1:11750 HIGHLAND RD
Practice Address - Street 2:SUITE 300
Practice Address - City:HARTLAND
Practice Address - State:MI
Practice Address - Zip Code:48353-2734
Practice Address - Country:US
Practice Address - Phone:810-599-0196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-13
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501000250174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist