Healthcare Provider Details

I. General information

NPI: 1043123920
Provider Name (Legal Business Name): SEAN C MOYLAN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 WELLNESS DR
MIDLAND MI
48670-2000
US

IV. Provider business mailing address

1007 TERRACE LN
YPSILANTI MI
48198-3085
US

V. Phone/Fax

Practice location:
  • Phone: 989-839-3000
  • Fax:
Mailing address:
  • Phone: 989-245-9641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: