Basic Information
| Provider Information | |||||||||
| NPI: | 1356338958 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DECARLI | ||||||||
| FirstName: | KAYLYNN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O | ||||||||
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| Mailing Information | |||||||||
| Address1: | 601 JOHN STREET | ||||||||
| Address2: | BOX 39 | ||||||||
| City: | KALAMAZOO | ||||||||
| State: | MI | ||||||||
| PostalCode: | 49007 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 601 S US HIGHWAY 131 | ||||||||
| Address2: | |||||||||
| City: | THREE RIVERS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490938831 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2692867070 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2005 | ||||||||
| LastUpdateDate: | 08/31/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/31/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QB0002X | 5101015461 | MI | N | Allopathic & Osteopathic Physicians | Family Medicine | Bariatric Medicine | 207Q00000X | 5101015461 | MI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.