Healthcare Provider Details

I. General information

NPI: 1962784652
Provider Name (Legal Business Name): NICHOLAS SPRINGSTEAD PA-C, MSM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2011
Last Update Date: 08/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 EAST MEDICAL CENTER DRIVE 2ND FLOOR C.S. MOTT CHILDREN'S HOSPITAL RECP A
ANN ARBOR MI
48109-4227
US

IV. Provider business mailing address

3621 SOUTH STATE STREET 700 KMS PLACE
ANN ARBOR MI
48108
US

V. Phone/Fax

Practice location:
  • Phone: 734-936-5730
  • Fax: 734-615-0544
Mailing address:
  • Phone: 734-936-2047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601006119
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: