Kellie Distefano, PA-C

NPI #1386609543 in Hartford, Michigan

Provider Information

NPI Number: 1386609543
Entity Type: Individual
Name: Kellie Distefano, PA-C
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Family Medicine
Credential: PA-C
Enumeration Date: Apr 19, 2006
Last Updated: Dec 18, 2007

Practice Location

Address: 525 S CENTER ST
City: Hartford
State: Michigan
ZIP Code: 49057-1362
Phone: (269) 621-4063

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Family Medicine	207Q00000X	Primary
Physician Assistant	363A00000X

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