Kevin Bruce Marchildon, CNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

4704246454 Issued in MI

Practice address

5325 Elliott Dr FL 2
Ypsilanti, MI 48197-8633

Phone

(734) 712-8000

Fax

(734) 712-8010

NPI assigned

Apr 7, 2019

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Practitioner

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1554595200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1573603200000",
    "number": "1508329699",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24 FRANK LLOYD WRIGHT DR STE J2000",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481059484",
            "telephone_number": "734-747-6766",
            "fax_number": "734-222-3100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5325 ELLIOTT DR FL 2",
            "city": "YPSILANTI",
            "state": "MI",
            "postal_code": "481978633",
            "telephone_number": "734-712-8000",
            "fax_number": "734-712-8010"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "14555 LeVan Rd Ste 203",
            "address_purpose": "LOCATION",
            "city": "Livonia",
            "state": "MI",
            "postal_code": "481545085",
            "country_code": "US",
            "telephone_number": "734-462-3233",
            "fax_number": "734-853-1507",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MARCHILDON",
        "first_name": "KEVIN",
        "middle_name": "BRUCE",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-04-07",
        "last_updated": "2019-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704246454",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alfred Mansour, PHD
• Sara Marasco, LMSW
• Aaron Maraugha, CRNA
• Lauren Marcath
• Janice Ginger Marchildon, APRN-BC
• Mariam Health Services PLC
• Kenneth Brian Marion
• Emily Louise Maris, M.D.
• Amin Marji, MD
• Mark J Klein, DPM, PC

• Family Nurse Practitioner in Ypsilanti, MI
• Providers in Ypsilanti, MI by specialty
• Family Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.