Healthcare Provider Details

I. General information

NPI: 1669823035
Provider Name (Legal Business Name): STEPHANIE KUHAR PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE SHOULDERS

II. Dates (important events)

Enumeration Date: 06/28/2016
Last Update Date: 06/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16001 W 9 MILE RD
SOUTHFIELD MI
48075-4818
US

IV. Provider business mailing address

PO BOX 100
ROYAL OAK MI
48068-0100
US

V. Phone/Fax

Practice location:
  • Phone: 248-849-3331
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601007839
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: