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NPI Code Detail

MEDICARE: JENNY GILES PAC

MEDICARE: JENNY GILES PAC
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 Assistant5601003727MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1457497471
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNY GILES PAC
Provider Business Mailing Address
First Line : 1206 WASHINGTON AVE
Second Line :
City : PORT HURON
State : MI
Zip : 48060-3555
Country : US
Telephone Number : 810-985-6778
Fax Number :
Provider Business Practice Location Address
First Line : 4071 24TH AVE
Second Line :
City : FORT GRATIOT
State : MI
Zip : 48059-3801
Country : US
Telephone Number : 810-824-4222
Fax Number : 810-824-4220
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/29/2007
Last Update Date : 09/21/2020

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Directions to “ JENNY GILES PAC” Practice Location

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