Individual
KATE MERYL SUPIANOSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
4660 S HAGADORN RD, STE 420, EAST LANSING, MI 48823
(517) 884-6100
(517) 884-6233
Mailing address
804 SERVICE RD, A201, EAST LANSING, MI 48824-7015
(517) 884-2976
(517) 432-3928
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
5601005114
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1679767222
—
MI
Enumeration date
08/28/2007
Last updated
06/09/2016
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