Provider Demographics
NPI:1164063368
Name:VAZALES, KIIRA (PA)
Entity type:Individual
Prefix:
First Name:KIIRA
Middle Name:
Last Name:VAZALES
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:630 W MITCHELL ST STE 4
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-2214
Mailing Address - Country:US
Mailing Address - Phone:231-348-4005
Mailing Address - Fax:833-973-5899
Practice Address - Street 1:630 W MITCHELL ST STE 4
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-2214
Practice Address - Country:US
Practice Address - Phone:231-348-4005
Practice Address - Fax:833-973-5899
Is Sole Proprietor?:No
Enumeration Date:2019-09-30
Last Update Date:2025-10-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDPA1796207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery