Most Relevant Information
Provider Data
| NPI Number: | 1003217860 |
| Provider Name: | KELLY MALIA PETERSON PA-C |
| Entity Type: | Individual |
| Taxonomy Code: | 363A00000X |
| Specialty: | Physician Assistant |
| License Number: | 5601007197 |
Most Important Dates
| Enumeration Date: | 09/11/2014 |
| Last Updated: | 08/05/2019 |
Provider Practice Location
1301 MERCY DRIVE
MUSKEGON
MI
49444
Practice Location Phone/Fax
| Phone: | 2317399492 |
| Fax: |
Provider Mailing Location
3621 S STATE ST
ANN ARBOR
MI
481081633
Provider Mailing Phone/Fax
| Phone: | 7346475299 |
| Fax: |