Provider Demographics
NPI:1508448713
Name:HAKALA, TINA
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:HAKALA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22725 GREATER MACK AVE BLDG B
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-2023
Mailing Address - Country:US
Mailing Address - Phone:586-217-2041
Mailing Address - Fax:
Practice Address - Street 1:22725 GREATER MACK AVE BLDG B
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-2023
Practice Address - Country:US
Practice Address - Phone:586-217-2041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-27
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date: