MEDICARE: COURTNEY MARIE MICH 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	5601005869	MI

General Provider Information

NPI Number	:	1588971584
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY MARIE MICH PA-C

Provider Business Mailing Address
First Line	:	1000 W UNIVERSITY DR STE 314
Second Line	:
City	:	ROCHESTER
State	:	MI
Zip	:	48307-1876
Country	:	US
Telephone Number	:	248-375-4033
Fax Number	:	248-375-4034

Provider Business Practice Location Address
First Line	:	1000 W UNIVERSITY DR STE 314
Second Line	:
City	:	ROCHESTER
State	:	MI
Zip	:	48307-1876
Country	:	US
Telephone Number	:	248-375-4033
Fax Number	:	248-375-4034

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

Provider Enumeration Date	:	09/12/2010
Last Update Date	:	02/05/2025

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Directions to “ COURTNEY MARIE MICH PA-C” Practice Location

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