Individual
KELLY PEREZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
15100 WHITTAKER WAY, GRAND HAVEN, MI 49417-8696
(616) 935-6210
Mailing address
1700 OAK AVE, MUSKEGON, MI 49442-2407
(231) 672-6580
(231) 672-6256
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601002517
MI
363AM0700X
Medical Physician Assistant
5601002517
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0C91143
BCBSM
MI
Enumeration date
10/31/2006
Last updated
01/03/2022
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