Provider Demographics
NPI:1366877052
Name:MAHALAK, KELLY ANN
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:ANN
Last Name:MAHALAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21316 SEVERN RD
Mailing Address - Street 2:
Mailing Address - City:HARPER WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48225-2372
Mailing Address - Country:US
Mailing Address - Phone:586-533-7680
Mailing Address - Fax:
Practice Address - Street 1:21316 SEVERN RD
Practice Address - Street 2:
Practice Address - City:HARPER WOODS
Practice Address - State:MI
Practice Address - Zip Code:48225-2372
Practice Address - Country:US
Practice Address - Phone:586-533-7680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-12
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula