Provider Demographics
NPI:1902319387
Name:KAMP, ALEX J (DPT)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:J
Last Name:KAMP
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 30516
Mailing Address - Street 2:DEPT 5300
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48909
Mailing Address - Country:US
Mailing Address - Phone:269-372-1027
Mailing Address - Fax:269-372-2940
Practice Address - Street 1:5819 BALSAM DR
Practice Address - Street 2:
Practice Address - City:HUDSONVILLE
Practice Address - State:MI
Practice Address - Zip Code:49426
Practice Address - Country:US
Practice Address - Phone:616-209-5435
Practice Address - Fax:269-372-2940
Is Sole Proprietor?:No
Enumeration Date:2017-11-08
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5501018444208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation