NPIMap

Individual provider Active NPI

Kimberly Rose Azelton, MD

  • Family Medicine Physician
  • Holt, MI
National Provider Identifier
1972038594
Registry record updated Mar 23, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
4301504512 Issued in MI
Practice address
4410 Holt Rd
Holt, MI 48842-1673
Phone
(574) 647-7477
Fax
(574) 647-3655
NPI assigned
Apr 21, 2017
Reactivated
Nov 14, 2023
Last updated
Mar 23, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 4301504512 MI Primary

Addresses

Primary practice location

4410 Holt Rd
Holt, MI 48842-1673

Mailing address

4410 Holt Rd
Holt, MI 48842-1673
Phone (517) 258-0855

Other identifiers 1

IdentifierTypeStateIssuer
300005661MedicaidIN

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address drkim@familyandlifestylemedicine.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211022000616 MI Practitioner - Family Practice 9537438908 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2017
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

4000 Wellness Dr
Midland, MI 48670-2000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Mymichigan Medical Group Family Medicine Current Accepting new patients
Mymichigan Medical Center Midland Past Accepting new patients

Locations

300 E Warwick Dr
Alma, MI 48801
Phone (989) 463-0104

4000 Wellness Dr
Midland, MI 48670
Phone (844) 832-1956

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1492732800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1774224000000",
    "number": "1972038594",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4410 HOLT RD",
            "city": "HOLT",
            "state": "MI",
            "postal_code": "488421673",
            "telephone_number": "517-258-0855",
            "fax_number": "517-210-2202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4410 HOLT RD",
            "city": "HOLT",
            "state": "MI",
            "postal_code": "488421673",
            "telephone_number": "574-647-7477",
            "fax_number": "574-647-3655"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AZELTON",
        "first_name": "KIMBERLY",
        "middle_name": "ROSE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-04-21",
        "last_updated": "2026-03-23",
        "certification_date": "2026-03-23",
        "deactivation_date": "2023-10-25",
        "reactivation_date": "2023-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301504512",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300005661",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "drkim@familyandlifestylemedicine.org",
            "affiliation": "N",
            "endpointDescription": "email hipaa compliant",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "pdf",
            "address_1": "12911 Kelly Ln",
            "city": "Grand Ledge",
            "state": "MI",
            "country_code": "US",
            "postal_code": "488378926",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Holt, MI

Sources for this page

Verify at the official NPI Registry.