Basic Information
| Provider Information | |||||||||
| NPI: | 1972539328 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GLOYSTEIN | ||||||||
| FirstName: | KIM | ||||||||
| MiddleName: | JEFFREY | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 363 FREMONT ST STE 203 | ||||||||
| Address2: | |||||||||
| City: | BATTLE CREEK | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490173398 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2699696123 | ||||||||
| FaxNumber: | 2699696122 | ||||||||
| Practice Location | |||||||||
| Address1: | 363 FREMONT ST STE 203 | ||||||||
| Address2: | |||||||||
| City: | BATTLE CREEK | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490173398 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2699696123 | ||||||||
| FaxNumber: | 2699696122 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2006 | ||||||||
| LastUpdateDate: | 01/09/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 4301049438 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 10/3236278 | 05 | MI | MEDICAID | 1417961137 | 01 | MI | BCBSM - BRONSON VICKSBURG OUTPATIENT CENTER | OTHER | 0C960650 | 01 | MI | BCBSM | OTHER | 1972539328 | 05 | MI | MEDICAID |