Individual
AMY ELIZABETH KLOK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3300 W CENTRE AVE, PORTAGE, MI 49024-4666
(269) 324-8950
(269) 324-2134
Mailing address
3300 W CENTRE AVE, PORTAGE, MI 49024-4666
(269) 324-8950
(269) 324-2134
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601005579
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
363A00000X
TAXONOMY
MI
01
—
5601005579
STATE LICENSE
MI
Enumeration date
09/10/2009
Last updated
11/27/2023
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