Provider Demographics
NPI:1265142202
Name:HEERA, KALASH (PA-C)
Entity type:Individual
Prefix:
First Name:KALASH
Middle Name:
Last Name:HEERA
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:804 SERVICE RD STE A109B
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48824-7015
Mailing Address - Country:US
Mailing Address - Phone:517-353-8122
Mailing Address - Fax:517-432-3713
Practice Address - Street 1:804 SERVICE RD STE A217
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48824-7015
Practice Address - Country:US
Practice Address - Phone:517-353-8122
Practice Address - Fax:517-432-3713
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-30
Last Update Date:2023-08-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5601011424363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant