Provider Demographics
NPI:1740069012
Name:MICHIGAN AMBULATORY
Entity type:Organization
Organization Name:MICHIGAN AMBULATORY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LYONEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LAGRONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-340-1774
Mailing Address - Street 1:414 GREENWICH PL
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-3304
Mailing Address - Country:US
Mailing Address - Phone:616-340-1774
Mailing Address - Fax:
Practice Address - Street 1:414 GREENWICH PL
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-3304
Practice Address - Country:US
Practice Address - Phone:616-340-1774
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)