Provider Demographics
NPI:1356025332
Name:MIHOLICS, KALLIE MARIE
Entity type:Individual
Prefix:
First Name:KALLIE
Middle Name:MARIE
Last Name:MIHOLICS
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 1:124 STOURBRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-1368
Mailing Address - Country:US
Mailing Address - Phone:484-948-5258
Mailing Address - Fax:
Practice Address - Street 1:724 N CHARLOTTE ST
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-4607
Practice Address - Country:US
Practice Address - Phone:610-323-1837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program