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General NPI Number Information
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NPI Number | 1023835808
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Entity Type | Individual
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Provider Name | KAYLA ERIN HALLECK PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/24/2024
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Last Update Date | 09/24/2024
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Provider Practice Location Address
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Address Line | 34025 HARPER AVE
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City | CLINTON TOWNSHIP
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State | MI
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Zip | 48035-3737
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Country | US
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Telephone | 586-445-9900
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Fax |
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Provider Business Mailing Address
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Address Line | 9347 SPARLING RD
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City | WALES
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State | MI
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Zip | 48027-1807
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Country | US
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Telephone | 586-770-3343
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5601012788
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License Number State | MI
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