Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Lucius Fairbotham, SPECIALIST

Individual provider Specialist · NPI 1497350516

Lucius Fairbotham, SPECIALIST is a Specialist in Kalamazoo, Michigan. Registered with an NPI since 2020.

In the registry since
2020
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Practice location Address checks out

610 S Burdick St
Kalamazoo, MI 49007-5221
Phone: (269) 381-3700
Fax: (269) 381-3700
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Specialist (primary) Taxonomy 174400000X

Record details

NPI number1497350516
Entity typeIndividual (Type 1)
GenderMale
Credentials SPECIALIST
Sole proprietorNo
NPI enumeratedDecember 4, 2020
Last updated in NPPESDecember 4, 2020
Certification dateDecember 4, 2020

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