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NPI Code Detail

MEDICARE: PAUL EDWARD MCKELLIP PA-C

MEDICARE: PAUL EDWARD MCKELLIP 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
1363A00000XPhysician Assistant3601008197MI

General Provider Information

NPI Number : 1104354166
Entity Type Code : Individual
Provider Name (Legal Business Name) : PAUL EDWARD MCKELLIP PA-C
Provider Business Mailing Address
First Line : 1106 ORCHARD RD
Second Line :
City : ESSEXVILLE
State : MI
Zip : 48732-1913
Country : US
Telephone Number : 989-414-7804
Fax Number :
Provider Business Practice Location Address
First Line : 2980 WILDER RD STE B
Second Line :
City : BAY CITY
State : MI
Zip : 48706-9213
Country : US
Telephone Number : 989-509-3333
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/02/2017
Last Update Date : 01/22/2025

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Directions to “ PAUL EDWARD MCKELLIP PA-C” Practice Location

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