Healthcare Provider Details

I. General information

NPI: 1093707101
Provider Name (Legal Business Name): FRANK P PILATO PAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 11/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5730 MAIN ST
LEXINGTON MI
48450-8800
US

IV. Provider business mailing address

5730 MAIN ST
LEXINGTON MI
48450-8800
US

V. Phone/Fax

Practice location:
  • Phone: 810-359-2605
  • Fax: 810-359-2748
Mailing address:
  • Phone: 810-359-2605
  • Fax: 810-359-2748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601003978
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: