Healthcare Provider Details

I. General information

NPI: 1720686348
Provider Name (Legal Business Name): MELINA KOKALES-GRAFOS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELINA KOKALES PA-C

II. Dates (important events)

Enumeration Date: 10/15/2020
Last Update Date: 12/16/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 S US HIGHWAY 131
THREE RIVERS MI
49093-8831
US

IV. Provider business mailing address

601 JOHN ST BOX 42
KALAMAZOO MI
49007-5341
US

V. Phone/Fax

Practice location:
  • Phone: 269-286-7070
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601010102
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: