Individual
MICAELA MURRAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
10400 75TH ST, KENOSHA, WI 53142-8323
(262) 948-5600
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
7599-023
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100262023
—
WI
05
—
1109109366
—
MI
Enumeration date
06/20/2017
Last updated
08/07/2024
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