Mikala Rae Gualtieri, PA is a medicare enrolled "Physician Assistant" physician in Norton Shores, Michigan. Her current practice location is
3570 Henry St Ste 120, Norton Shores, Michigan. You can reach out to her office (for appointments etc.) via phone at
(231) 672-7000.
Mikala Rae Gualtieri is licensed to practice in Michigan (license number 5601012938) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1669280384.
Physician's Profile
Full Name | Mikala Rae Gualtieri |
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Gender | Female |
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Speciality | Physician Assistant |
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Location | 3570 Henry St Ste 120, Norton Shores, Michigan |
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Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
NPI Data:
- NPI Number: 1669280384
- Provider Enumeration Date: 12/27/2024
- Last Update Date: 01/14/2025
Medicare PECOS Information:
- PECOS PAC ID: 6103354667
- Enrollment ID: I20250110003184
Medical Identifiers
Medical identifiers for Mikala Rae Gualtieri such as npi, medicare ID, medicare PIN, medicaid, etc.
Identifier | Type | State | Issuer |
1669280384 | NPI | - | NPPES |
Medical Taxonomies and Licenses
Taxonomy | Type | License (State) | Status |
207Q00000X | Family Medicine | 5601012938APP24 (Michigan) | Secondary |
363A00000X | Physician Assistant | 5601012938 (Michigan) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Mikala Rae Gualtieri is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
Mailing Address | Practice Location Address |
Mikala Rae Gualtieri, PA 892 College Ave, Holland, MI 49423-7050 Ph: (616) 510-6407 | Mikala Rae Gualtieri, PA 3570 Henry St Ste 120, Norton Shores, MI 49441-4576 Ph: (231) 672-7000 |
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