Healthcare Provider Details

I. General information

NPI: 1164063368
Provider Name (Legal Business Name): KIIRA VAZALES SPEIGL PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2019
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 W MITCHELL ST STE 4
PETOSKEY MI
49770-2214
US

IV. Provider business mailing address

630 W MITCHELL ST STE 4
PETOSKEY MI
49770-2214
US

V. Phone/Fax

Practice location:
  • Phone: 231-348-4005
  • Fax: 833-973-5899
Mailing address:
  • Phone: 231-348-4005
  • Fax: 833-973-5899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberPA1796
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: