Individual
KAYLA R LICARI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.-C
Contact information
Practice address
3700 52ND ST SE, GRAND RAPIDS, MI 49512-9637
(616) 656-3700
(616) 656-3701
Mailing address
3700 52ND ST SE, GRAND RAPIDS, MI 49512-9637
(616) 656-3700
(616) 656-3701
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
5601005659
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5601005659
STATE LICENSE
MI
Enumeration date
11/30/2009
Last updated
11/30/2009
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