Provider Demographics
NPI:1285291138
Name:KIRIAZIS, CARINA (PA-C)
Entity type:Individual
Prefix:
First Name:CARINA
Middle Name:
Last Name:KIRIAZIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44344 DEQUINDRE RD STE 480
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48314-1042
Mailing Address - Country:US
Mailing Address - Phone:586-323-8935
Mailing Address - Fax:586-323-9058
Practice Address - Street 1:44344 DEQUINDRE RD STE 480
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48314-1042
Practice Address - Country:US
Practice Address - Phone:586-323-9058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-28
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601009192363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant