Healthcare Provider Details

I. General information

NPI: 1396490991
Provider Name (Legal Business Name): HAYLEY JO ALTSHULER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2022
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39450 W TWELVE MILE RD
NOVI MI
48377-3600
US

IV. Provider business mailing address

13016 WOODRIDGE CIR
PLYMOUTH MI
48170-3892
US

V. Phone/Fax

Practice location:
  • Phone: 248-661-6478
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601012350
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: