Provider Demographics
NPI:1609307347
Name:KANGAS-DICK, AERYN NAOMI (MD)
Entity type:Individual
Prefix:
First Name:AERYN
Middle Name:NAOMI
Last Name:KANGAS-DICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:200 N PARK ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-3731
Mailing Address - Country:US
Mailing Address - Phone:269-382-2500
Mailing Address - Fax:269-373-7478
Practice Address - Street 1:200 N PARK ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-3731
Practice Address - Country:US
Practice Address - Phone:269-382-2500
Practice Address - Fax:269-373-7478
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-24
Last Update Date:2025-08-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301514752208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery