Healthcare Provider Details

I. General information

NPI: 1689626418
Provider Name (Legal Business Name): MICHAEL AHERN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 08/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6290 JUPITER AVE NE SUITE A
BELMONT MI
49306-8884
US

IV. Provider business mailing address

6290 JUPITER AVE NE SUITE A
BELMONT MI
49306-8884
US

V. Phone/Fax

Practice location:
  • Phone: 616-301-2500
  • Fax: 616-301-2501
Mailing address:
  • Phone: 616-301-2500
  • Fax: 616-301-2501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601002931
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: