Healthcare Provider Details

I. General information

NPI: 1013723774
Provider Name (Legal Business Name): ALANA MARIE KUGELARD PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2024
Last Update Date: 12/09/2024
Certification Date: 12/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 CHERRY ST SE FL 2
GRAND RAPIDS MI
49503-4608
US

IV. Provider business mailing address

1494 34TH ST
ALLEGAN MI
49010-9306
US

V. Phone/Fax

Practice location:
  • Phone: 616-685-5576
  • Fax:
Mailing address:
  • Phone: 616-644-4127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: