Individual
KELLY MICHELLE MCGILLICUDDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
2750 E BELTLINE AVE NE, GRAND RAPIDS, MI 49525-8614
(616) 267-7015
Mailing address
100 MICHIGAN ST NE # MC845, GRAND RAPIDS, MI 49503-2560
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601008325
MI
Other
Enumeration date
06/21/2017
Last updated
05/23/2022
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