Individual
KELLY J GINGRAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
18101 OAKWOOD BLVD, DEARBORN, MI 48124-4089
(313) 982-5440
Mailing address
26901 BEAUMONT BLVD STE 3D, SOUTHFIELD, MI 48033-3849
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601005311
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
311098079
TAX ID #
—
01
—
353077
SUBMITTER NO.
—
01
—
PA25091
PALMETTO MEDICARE
—
Enumeration date
05/04/2006
Last updated
10/07/2022
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