Provider Demographics
NPI:1043645286
Name:PAPKE, PAULA KAY (PAC)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:KAY
Last Name:PAPKE
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:744 W MICHIGAN AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-1900
Mailing Address - Country:US
Mailing Address - Phone:248-894-1874
Mailing Address - Fax:
Practice Address - Street 1:744 W MICHIGAN AVE STE 200
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-1900
Practice Address - Country:US
Practice Address - Phone:517-205-3120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-06
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601006771363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI12609283OtherCAQH