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NPI Code Detail

MEDICARE: STEPHANIE KOLO PA-C

MEDICARE: STEPHANIE KOLO PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant

General Provider Information

NPI Number : 1356947212
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHANIE KOLO PA-C
Provider Business Mailing Address
First Line : 363 GREENLEAF DR
Second Line :
City : HOUGHTON LAKE
State : MI
Zip : 48629-8952
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1680 HARTWICK PINES RD
Second Line :
City : GRAYLING
State : MI
Zip : 49738-9237
Country : US
Telephone Number : 989-302-2002
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/07/2020
Last Update Date : 09/09/2024

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Directions to “ STEPHANIE KOLO PA-C” Practice Location

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