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General NPI Number Information
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NPI Number | 1023152147
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Entity Type | Individual
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Provider Name | MICHAEL T PRICE PA-C
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Gender | Male
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Dates
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Enumeration Date | 02/20/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 19401 HUBBARD DRIVE HENRY FORD HOSPITAL FAIRLAINE ER
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City | DEARBORN
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State | MI
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Zip | 48126
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Country | US
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Telephone | 313-982-8369
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Fax |
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Provider Business Mailing Address
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Address Line | 1560 COLUMBIA RD
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City | BERKLEY
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State | MI
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Zip | 48072-1914
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Country | US
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Telephone | 248-547-3396
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5601002362
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License Number State | MI
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