Provider Demographics
NPI:1558517300
Name:VALOIS, CAROLYN M (PA-C)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:M
Last Name:VALOIS
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 1:8558 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-7032
Mailing Address - Country:US
Mailing Address - Phone:219-392-7084
Mailing Address - Fax:219-703-6854
Practice Address - Street 1:901 MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2959
Practice Address - Country:US
Practice Address - Phone:219-836-1600
Practice Address - Fax:219-703-6622
Is Sole Proprietor?:No
Enumeration Date:2008-08-13
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10001024A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000636955OtherANTHEM BLUE CROSS BLUE SHIELD
IN300006683Medicaid
INP01192139OtherRR MEDICARE PTAN
IN266180118Medicare PIN