Healthcare Provider Details

I. General information

NPI: 1205208956
Provider Name (Legal Business Name): JASON R HILL PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2015
Last Update Date: 07/28/2022
Certification Date: 07/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44201 DEQUINDRE RD STE EC
TROY MI
48085-1117
US

IV. Provider business mailing address

8869 MESKILL
COLUMBUS MI
48063
US

V. Phone/Fax

Practice location:
  • Phone: 248-964-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number019238
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601007703
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: