Healthcare Provider Details

I. General information

NPI: 1922556190
Provider Name (Legal Business Name): KAITLIN MARIE LALONDE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAITLIN MARIE KLINGSHIRN PA-C

II. Dates (important events)

Enumeration Date: 09/16/2016
Last Update Date: 02/02/2021
Certification Date: 02/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 S MAIN ST FL 2
CHEBOYGAN MI
49721-2220
US

IV. Provider business mailing address

1035 W WASHINGTON AVE
ALPENA MI
49707-2929
US

V. Phone/Fax

Practice location:
  • Phone: 231-627-7118
  • Fax:
Mailing address:
  • Phone: 989-736-9815
  • Fax: 989-358-3734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601007916
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: