Healthcare Provider Details

I. General information

NPI: 1265407530
Provider Name (Legal Business Name): GINNIE MARIE SPADAFORE-BARRETT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2455 UNION LAKE RD STE 101
COMMERCE TOWNSHIP MI
48382-3596
US

IV. Provider business mailing address

1501 N MILFORD RD STE 200
MILFORD MI
48381-1049
US

V. Phone/Fax

Practice location:
  • Phone: 248-363-2239
  • Fax: 248-363-3517
Mailing address:
  • Phone: 482-717-0585
  • Fax: 248-717-0845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601004186
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: