Healthcare Provider Details

I. General information

NPI: 1265142202
Provider Name (Legal Business Name): KALASH HEERA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2022
Last Update Date: 08/16/2023
Certification Date: 08/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 SERVICE RD STE A217
EAST LANSING MI
48824-7015
US

IV. Provider business mailing address

804 SERVICE RD STE A109B
EAST LANSING MI
48824-7015
US

V. Phone/Fax

Practice location:
  • Phone: 517-353-8122
  • Fax: 517-432-3713
Mailing address:
  • Phone: 517-353-8122
  • Fax: 517-432-3713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601011424
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: