Provider Demographics
NPI:1285743393
Name:CAHILL, PAULA L (MD)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:L
Last Name:CAHILL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 MUNSON AVE, SUITE 200
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686
Mailing Address - Country:US
Mailing Address - Phone:231-935-8717
Mailing Address - Fax:231-935-9230
Practice Address - Street 1:550 MUNSON AVE, SUITE 200
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686
Practice Address - Country:US
Practice Address - Phone:231-935-8717
Practice Address - Fax:231-935-9230
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301063462207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0702803192OtherBLUE CROSS BLUE SHIELD
MI070010119OtherRAILROAD MEDICARE
MI3347473Medicaid
MI38-2170687OtherPRIORITY HEALTH
MIM008816OtherTRICARE
MI070010119OtherRAILROAD MEDICARE
MIP20650003Medicare ID - Type Unspecified