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General NPI Number Information
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NPI Number | 1093139982
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Entity Type | Individual
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Provider Name | JAMES PAIL PAC
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Gender | Male
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Dates
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Enumeration Date | 02/12/2014
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Last Update Date | 02/19/2024
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Provider Practice Location Address
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Address Line | 863 N PINE RD STE F
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City | ESSEXVILLE
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State | MI
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Zip | 48732-2159
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Country | US
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Telephone | 989-948-4799
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Fax |
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Provider Business Mailing Address
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Address Line | 2610 E HURLEY RD
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City | MIDLAND
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State | MI
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Zip | 48642-7376
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Country | US
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Telephone | 989-948-4799
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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 | 999999999
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License Number State | MI
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