Provider Demographics
NPI:1437678992
Name:KOULARMANIS, MARIA (PA-C)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:KOULARMANIS
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 1:815 SAINT JOSEPH DR
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-2529
Mailing Address - Country:US
Mailing Address - Phone:269-983-3455
Mailing Address - Fax:269-983-5920
Practice Address - Street 1:815 SAINT JOSEPH DR
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-2529
Practice Address - Country:US
Practice Address - Phone:269-983-3455
Practice Address - Fax:269-983-5920
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-15
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5601009905363A00000X
IL085.006243363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant