Healthcare Provider Details

I. General information

NPI: 1285633172
Provider Name (Legal Business Name): ADAM J GELLER PAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 04/19/2024
Certification Date: 04/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 MERCY DR STE 100
MUSKEGON MI
49444-1833
US

IV. Provider business mailing address

1400 MERCY DR STE 100
MUSKEGON MI
49444-1833
US

V. Phone/Fax

Practice location:
  • Phone: 231-830-2748
  • Fax: 231-733-5212
Mailing address:
  • Phone: 231-733-1326
  • Fax: 231-733-5212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number5601003015
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601003015
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: