Healthcare Provider Details

I. General information

NPI: 1194174821
Provider Name (Legal Business Name): MEGAN CATHERINE BECKERICH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEGAN CATHERINE BRAGG PA-C

II. Dates (important events)

Enumeration Date: 06/03/2016
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31500 TELEGRAPH RD STE 225
BINGHAM FARMS MI
48025-4315
US

IV. Provider business mailing address

31500 TELEGRAPH RD STE 225
BINGHAM FARMS MI
48025-4315
US

V. Phone/Fax

Practice location:
  • Phone: 248-552-0620
  • Fax:
Mailing address:
  • Phone: 248-552-0620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601007806
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: