Provider Demographics
NPI:1710956560
Name:ROELANT, CHARLES PAUL (PA-C)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:PAUL
Last Name:ROELANT
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:601 JOHN ST
Mailing Address - Street 2:SUITE M-206C
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-5341
Mailing Address - Country:US
Mailing Address - Phone:269-349-9745
Mailing Address - Fax:269-488-8305
Practice Address - Street 1:601 JOHN ST
Practice Address - Street 2:SUITE M-206C
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-5341
Practice Address - Country:US
Practice Address - Phone:269-349-9745
Practice Address - Fax:269-488-8305
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2601004675363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP00606306OtherMEDICARE RAILROAD
MI0N83160005Medicare PIN