Basic Information
| Provider Information | |||||||||
| NPI: | 1639656721 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCLEOD | ||||||||
| FirstName: | KALI | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | C-NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 28001 HARPER AVE | ||||||||
| Address2: | |||||||||
| City: | SAINT CLAIR SHORES | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480811561 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5867727180 | ||||||||
| FaxNumber: | 5862790033 | ||||||||
| Practice Location | |||||||||
| Address1: | 28001 HARPER AVE | ||||||||
| Address2: | |||||||||
| City: | SAINT CLAIR SHORES | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480811561 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5867727180 | ||||||||
| FaxNumber: | 5862790033 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/23/2018 | ||||||||
| LastUpdateDate: | 07/23/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 4704301644 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.