person
Kelly Rose Mikail, PA-C
Medical Physician Assistant in Grand Rapids, Michigan
NPI 1497075766

Kelly Rose Mikail is a Medical Physician Assistant based in Grand Rapids, MI and is specialized in Medical. Kelly Rose Mikail practices in Grand Rapids, MI and has the professional credentials of PA-C. The NPI Number for Kelly Rose Mikail is 1497075766 and holds a License No. 5601005774 (Michigan).

The current practice location address for Kelly Rose Mikail is 4100 Lake Dr Se, Grand Rapids, MI and can be reached out via phone at 616-267-7293 and via fax at 616-267-7228.

Location: 4100 Lake Dr Se, Grand Rapids, MI, 49503-2560
person
Provider Profile Details
NPI Number
1497075766
Provider Name
Kelly Rose Mikail
Credential
PA-C
Provider Entity Type
Individual
Gender
Female
Address
4100 Lake Dr Se, Grand Rapids, MI, 49503-2560
Phone Number
616-267-7293
Fax Number
616-267-7228
Provider Enumeration Date
06/09/2010
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
1497075766 05 MI
institution
Provider Business Practice Location Address Details
Address
4100 Lake Dr Se
City
State
Zip
49546-8292
Phone Number
616-267-7293
Fax Number
616-267-7228
person
Provider Business Mailing Address Details
Address
4100 Lake Dr Se
City
State
Zip
49546-8292
Phone Number
616-267-7293
Fax Number
616-267-7228
person
Provider's Taxonomy Details 1
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Physician Assistant
Speciality
Medical
Taxonomy
License No.
5601005774 (Michigan)
Definition
Definition to come...
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