Healthcare Provider Details

I. General information

NPI: 1861315376
Provider Name (Legal Business Name): ETHAN MELTON PA-C
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1447 N HARRISON ST
SAGINAW MI
48602-4727
US

IV. Provider business mailing address

PO BOX 21
MOUNT PLEASANT MI
48804-0021
US

V. Phone/Fax

Practice location:
  • Phone: 989-583-7000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number5601014216
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number5601014216
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: