Provider Demographics
NPI:1871167759
Name:MICHALAK, JOEL ERIC (PA-C)
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:ERIC
Last Name:MICHALAK
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5815 COPPER BEECH BLVD APT A
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-5724
Mailing Address - Country:US
Mailing Address - Phone:734-474-3581
Mailing Address - Fax:
Practice Address - Street 1:5815 COPPER BEECH BLVD APT A
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-5724
Practice Address - Country:US
Practice Address - Phone:734-474-3581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-17
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601010062363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant