Basic Information
| Provider Information | |||||||||
| NPI: | 1790876894 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BACALIA | ||||||||
| FirstName: | AARON | ||||||||
| MiddleName: | MICHAEL | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 606 ELM ST | ||||||||
| Address2: | |||||||||
| City: | KALAMAZOO | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490073235 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2693527311 | ||||||||
| FaxNumber: | 2693852657 | ||||||||
| Practice Location | |||||||||
| Address1: | 6010 GULL RD | ||||||||
| Address2: | |||||||||
| City: | KALAMAZOO | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490489452 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2693854671 | ||||||||
| FaxNumber: | 2693852657 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2006 | ||||||||
| LastUpdateDate: | 12/04/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 5601004843 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 363A00000X | 5601004843 | MI | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 5601004843 | 01 | MI | PERMANENT ID NUMBER | OTHER |