Basic Information
| Provider Information | |||||||||
| NPI: | 1063025096 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KADE | ||||||||
| FirstName: | JOIE | ||||||||
| MiddleName: | NIKOLE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10579 W COUNTY LINE RD | ||||||||
| Address2: | |||||||||
| City: | BLANCHARD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 493109285 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9898182917 | ||||||||
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| Practice Location | |||||||||
| Address1: | 623 W WARWICK DR STE 2 | ||||||||
| Address2: | |||||||||
| City: | ALMA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488011177 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9892851490 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2020 | ||||||||
| LastUpdateDate: | 08/28/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | Y |
No ID Information.