Provider Demographics
NPI: | 1902864135 |
---|---|
Name: | TERMUHLEN, PAULA M (MD) |
Entity type: | Individual |
Prefix: | |
First Name: | PAULA |
Middle Name: | M |
Last Name: | TERMUHLEN |
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: | 1000 OAKLAND DR |
Mailing Address - Street 2: | |
Mailing Address - City: | KALAMAZOO |
Mailing Address - State: | MI |
Mailing Address - Zip Code: | 49008-1282 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 269-337-6019 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1000 OAKLAND DR |
Practice Address - Street 2: | |
Practice Address - City: | KALAMAZOO |
Practice Address - State: | MI |
Practice Address - Zip Code: | 49008-1282 |
Practice Address - Country: | US |
Practice Address - Phone: | 269-337-6019 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-05-04 |
Last Update Date: | 2021-11-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MI | 4301505576 | 208600000X |
OH | 35079593 | 208600000X |
MN | 59273 | 2086X0206X |
WI | 56090 | 2086X0206X |
OH | 35-079593 | 2086X0206X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 208600000X | Allopathic & Osteopathic Physicians | Surgery | |
No | 2086X0206X | Allopathic & Osteopathic Physicians | Surgery | Surgical Oncology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
OH | 2252575 | Medicaid | |
OH | 2252575 | Medicaid | |
TE4050412 | Medicare PIN |