Provider Demographics
NPI:1154089530
Name:KARUNGI, GLORIA KATO (PA-C)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:KATO
Last Name:KARUNGI
Suffix:
Gender:F
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 1:34633 LYTLE ST UNIT 152
Mailing Address - Street 2:
Mailing Address - City:FARMINGTN HLS
Mailing Address - State:MI
Mailing Address - Zip Code:48335-4057
Mailing Address - Country:US
Mailing Address - Phone:313-801-8257
Mailing Address - Fax:
Practice Address - Street 1:9178 HIGHLAND RD STE 1
Practice Address - Street 2:
Practice Address - City:WHITE LAKE
Practice Address - State:MI
Practice Address - Zip Code:48386-4619
Practice Address - Country:US
Practice Address - Phone:248-698-1999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-02
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5601010724363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant