Individual
MS. ANN E. SOUKUP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
900 PEELER ST, KALAMAZOO, MI 49008-2380
(269) 345-8618
(269) 345-1508
Mailing address
900 PEELER ST, KALAMAZOO, MI 49008-2380
(269) 345-8618
(269) 345-1508
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601001432
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5601001432
MI LICENSE
MI
01
—
N93340005
MEDICARE PTAN
MI
Enumeration date
10/19/2007
Last updated
02/14/2008
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