MEDICARE: MRS. HELENA PUHALJ P.A.-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	5601002338	MI
2	363A00000X	Physician Assistant	5601002338	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1417961137	OTHER	MI	BCBSM - BMH

General Provider Information

NPI Number	:	1386756740
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HELENA PUHALJ P.A.-C

Provider Business Mailing Address
First Line	:	535 S BURDICK ST
Second Line	:
City	:	KALAMAZOO
State	:	MI
Zip	:	49007-5294
Country	:	US
Telephone Number	:	269-341-8822
Fax Number	:	269-341-7518

Provider Business Practice Location Address
First Line	:	535 S BURDICK ST
Second Line	:
City	:	KALAMAZOO
State	:	MI
Zip	:	49007-5294
Country	:	US
Telephone Number	:	269-341-8822
Fax Number	:	269-341-7518

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	11/27/2023

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