Provider Demographics
NPI:1255004511
Name:BRAR, MEHAR KAUR (PA-C)
Entity Type:Individual
Prefix:
First Name:MEHAR
Middle Name:KAUR
Last Name:BRAR
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 1:361 MANHATTAN RD SE
Mailing Address - Street 2:
Mailing Address - City:EAST GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-2018
Mailing Address - Country:US
Mailing Address - Phone:517-614-3619
Mailing Address - Fax:
Practice Address - Street 1:6401 PRAIRIE ST STE 1700
Practice Address - Street 2:
Practice Address - City:NORTON SHORES
Practice Address - State:MI
Practice Address - Zip Code:49444-7843
Practice Address - Country:US
Practice Address - Phone:231-672-7944
Practice Address - Fax:231-727-7812
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-31
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MI5601010892363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program