Healthcare Provider Details

I. General information

NPI: 1902689409
Provider Name (Legal Business Name): MEGAN NICOLE MARCON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEGAN NICOLE MCKENZIE PA-C

II. Dates (important events)

Enumeration Date: 08/17/2023
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 E CENTRE AVE
PORTAGE MI
49002-5500
US

IV. Provider business mailing address

601 JOHN STREET BOX 42
KALAMAZOO MI
49007
US

V. Phone/Fax

Practice location:
  • Phone: 269-286-7050
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601011935
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: