Healthcare Provider Details

I. General information

NPI: 1356812697
Provider Name (Legal Business Name): AARON T MISNER NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2018
Last Update Date: 12/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 ELECTRIC AVE
PORT HURON MI
48060-6587
US

IV. Provider business mailing address

22419 MILNER ST
SAINT CLAIR SHORES MI
48081-2078
US

V. Phone/Fax

Practice location:
  • Phone: 810-216-1500
  • Fax:
Mailing address:
  • Phone: 586-876-2122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number4704286735
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: