Provider Demographics
NPI:1386755593
Name:LABADIE, PAULA KIRK (PA-C)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:KIRK
Last Name:LABADIE
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 1:19229 MACK AVENUE
Mailing Address - Street 2:SUITE 34
Mailing Address - City:GROSSE POINTE WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48236
Mailing Address - Country:US
Mailing Address - Phone:313-647-3900
Mailing Address - Fax:313-647-3902
Practice Address - Street 1:19229 MACK AVENUE
Practice Address - Street 2:SUITE 34
Practice Address - City:GROSSE POINTE WOODS
Practice Address - State:MI
Practice Address - Zip Code:48236
Practice Address - Country:US
Practice Address - Phone:313-647-3900
Practice Address - Fax:313-647-3902
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601004070363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
N85790001Medicare ID - Type Unspecified