Provider Demographics
NPI:1558517300
Name:VALOIS, CAROLYN M (PA-C)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:M
Last Name:VALOIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 781076
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48278-1076
Mailing Address - Country:US
Mailing Address - Phone:317-528-4800
Mailing Address - Fax:317-865-1479
Practice Address - Street 1:3500 FRANCISCAN WAY STE 400
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-0033
Practice Address - Country:US
Practice Address - Phone:219-861-8785
Practice Address - Fax:219-861-8789
Is Sole Proprietor?:No
Enumeration Date:2008-08-13
Last Update Date:2024-12-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN10001024A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP01192139OtherRR MEDICARE PTAN
IN000000636955OtherANTHEM BLUE CROSS BLUE SHIELD
IN300006683Medicaid
IN266180118Medicare PIN