MEDICARE: MRS. KARI JEAN EWALT MS, MA

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
1	363A00000X	Physician Assistant	5601011398	MI

General Provider Information

NPI Number	:	1962559682
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KARI JEAN EWALT MS, MA

Provider Business Mailing Address
First Line	:	1701 SOUTH BLVD E
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48307-6122
Country	:	US
Telephone Number	:	248-853-0803
Fax Number	:	248-852-5859

Provider Business Practice Location Address
First Line	:	1701 SOUTH BLVD E STE 110
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48307-6118
Country	:	US
Telephone Number	:	248-853-0803
Fax Number	:	248-852-5859

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2007
Last Update Date	:	05/01/2023

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