Provider Demographics
NPI:1386756740
Name:PUHALJ, HELENA (PA-C)
Entity type:Individual
Prefix:MRS
First Name:HELENA
Middle Name:
Last Name:PUHALJ
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 1:535 S BURDICK ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-5294
Mailing Address - Country:US
Mailing Address - Phone:269-341-8822
Mailing Address - Fax:269-341-7518
Practice Address - Street 1:535 S BURDICK ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-5294
Practice Address - Country:US
Practice Address - Phone:269-341-8822
Practice Address - Fax:269-341-7518
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601002338363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1386756740Medicaid
MI1417961137OtherBCBSM - BMH