Provider Demographics
NPI:1811948953
Name:KASIM LTD
Entity type:Organization
Organization Name:KASIM LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:R
Authorized Official - Last Name:BENT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-785-8535
Mailing Address - Street 1:1550 3 MILE RD NW
Mailing Address - Street 2:SUITE B
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49544-8251
Mailing Address - Country:US
Mailing Address - Phone:616-785-8535
Mailing Address - Fax:616-785-1201
Practice Address - Street 1:1550 3 MILE RD NW
Practice Address - Street 2:SUITE B
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49544-8251
Practice Address - Country:US
Practice Address - Phone:616-785-8535
Practice Address - Fax:616-785-1201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-13
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3343400Medicaid
MI30656OtherBLUE CROSS BLUE SHIELD
MI30656OtherBLUE CROSS BLUE SHIELD