Individual
GRACE LORRAINE KALK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
940 S SAINT AUGUSTINE ST, PULASKI, WI 54162-9453
(920) 496-4700
(920) 496-4705
Mailing address
620 SMITH AVE, OCONTO, WI 54153-1080
(920) 834-4110
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1034
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42985400
—
WI
Enumeration date
07/22/2006
Last updated
12/20/2018
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