Healthcare Provider Details

I. General information

NPI: 1215170410
Provider Name (Legal Business Name): DANA ALEXANDRA BIEBEL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2009
Last Update Date: 09/07/2022
Certification Date: 09/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1104 CASS STREET
TRAVERSE CITY MI
49684
US

IV. Provider business mailing address

1104 CASS STREET
TRAVERSE CITY MI
49684
US

V. Phone/Fax

Practice location:
  • Phone: 231-941-1155
  • Fax: 231-259-1005
Mailing address:
  • Phone: 231-941-1155
  • Fax: 231-259-1005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1995
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: