Provider Demographics
NPI:1477677144
Name:KACER, KAREN M (PA-C)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:M
Last Name:KACER
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 1:32270 TELEGRAPH RD
Mailing Address - Street 2:STE 100
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-2456
Mailing Address - Country:US
Mailing Address - Phone:248-258-2888
Mailing Address - Fax:248-258-6849
Practice Address - Street 1:32270 TELEGRAPH RD
Practice Address - Street 2:STE 100
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-2456
Practice Address - Country:US
Practice Address - Phone:248-258-2888
Practice Address - Fax:248-258-6849
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI003187363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant