Healthcare Provider Details

I. General information

NPI: 1821545864
Provider Name (Legal Business Name): JOSHUA E HULKONEN PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2016
Last Update Date: 05/05/2021
Certification Date: 05/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 10TH AVE
MENOMINEE MI
49858-3058
US

IV. Provider business mailing address

894 CAMPUS DR STE B
HANCOCK MI
49930-1644
US

V. Phone/Fax

Practice location:
  • Phone: 906-290-5000
  • Fax:
Mailing address:
  • Phone: 906-483-1445
  • Fax: 906-483-1122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number5601007994
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: