Provider Demographics
NPI:1407887649
Name:SAMALIK, JULIA ANN (PA)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:ANN
Last Name:SAMALIK
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:829 N CENTER AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:GAYLORD
Mailing Address - State:MI
Mailing Address - Zip Code:49735-1595
Mailing Address - Country:US
Mailing Address - Phone:989-731-7860
Mailing Address - Fax:989-731-7954
Practice Address - Street 1:829 N CENTER AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:GAYLORD
Practice Address - State:MI
Practice Address - Zip Code:49735-1595
Practice Address - Country:US
Practice Address - Phone:989-731-7860
Practice Address - Fax:989-731-7954
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601003091363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
DA0074OtherMEDICARE RR PROV ID
DA0074OtherMEDICARE RR PROV ID
0M29550P03Medicare ID - Type UnspecifiedPROVIDER NUMBER