Healthcare Provider Details

I. General information

NPI: 1609162957
Provider Name (Legal Business Name): KALI CORINNE VANSTEE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KALI WHITE PA-C

II. Dates (important events)

Enumeration Date: 06/24/2011
Last Update Date: 04/18/2023
Certification Date: 04/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 HOBART ST
CADILLAC MI
49601-2379
US

IV. Provider business mailing address

302 HOBART ST
CADILLAC MI
49601-2379
US

V. Phone/Fax

Practice location:
  • Phone: 231-876-2644
  • Fax: 231-876-5106
Mailing address:
  • Phone: 231-876-2644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601006147
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: