Healthcare Provider Details

I. General information

NPI: 1508820150
Provider Name (Legal Business Name): PAMELA H STEINBERG PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 03/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20228 FARMINGTON ROAD
LIVONIA MI
48152
US

IV. Provider business mailing address

20228 FARMINGTON ROAD
LIVONIA MI
48152
US

V. Phone/Fax

Practice location:
  • Phone: 248-478-5221
  • Fax: 248-478-8425
Mailing address:
  • Phone: 248-478-5221
  • Fax: 248-478-8425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601001819
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: