Healthcare Provider Details

I. General information

NPI: 1437662087
Provider Name (Legal Business Name): SHEILA CLARE PUTNAM PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2017
Last Update Date: 03/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 MCAULEY DR
YPSILANTI MI
48197-1051
US

IV. Provider business mailing address

46640 AYRES AVE
BELLEVILLE MI
48111-1203
US

V. Phone/Fax

Practice location:
  • Phone: 734-787-8456
  • Fax:
Mailing address:
  • Phone: 734-787-8456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601008452
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: