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| Type | Person | [sources] | |||
|---|---|---|---|---|---|
| Name | Kellie Distefano | [sources] | |||
| Birth date | not available | [sources] | |||
| Nationality | not available | [sources] | |||
| Country | United States | [sources] | |||
| First name | Kellie | [sources] | |||
| Last name | Distefano | [sources] | |||
| NPI | 1386609543 | [sources] | |||
| Sector | Physician Assistant | [sources] | |||
| Address | Saugatuck, MI | [sources] | |||
| Last change | Last processed | First seen | |||
Providers who have been terminated for cause from Michigan's Medicaid program.
United States · MDHHS
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