MEDICARE: JEFFREY MICHAEL GANDY PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	5601003053	MI

General Provider Information

NPI Number	:	1033155478
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY MICHAEL GANDY PA-C

Provider Business Mailing Address
First Line	:	555 W WACKERLY ST
Second Line	:	SUITE 2600
City	:	MIDLAND
State	:	MI
Zip	:	48640-4722
Country	:	US
Telephone Number	:	989-839-8865
Fax Number	:	989-631-7337

Provider Business Practice Location Address
First Line	:	555 W WACKERLY ST
Second Line	:	SUITE 2600
City	:	MIDLAND
State	:	MI
Zip	:	48640-4722
Country	:	US
Telephone Number	:	989-839-8865
Fax Number	:	989-631-7337

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2006
Last Update Date	:	10/25/2011

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