Provider Demographics
NPI:1841859196
Name:PATTULLO, KARLEE (PA)
Entity type:Individual
Prefix:
First Name:KARLEE
Middle Name:
Last Name:PATTULLO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:385 N LAPEER RD
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48371-3610
Mailing Address - Country:US
Mailing Address - Phone:248-969-7354
Mailing Address - Fax:248-628-8802
Practice Address - Street 1:385 N LAPEER RD
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MI
Practice Address - Zip Code:48371-3610
Practice Address - Country:US
Practice Address - Phone:248-969-7354
Practice Address - Fax:248-628-8802
Is Sole Proprietor?:No
Enumeration Date:2019-06-11
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601009509363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant