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General NPI Number Information
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NPI Number | 1316335367
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Entity Type | Individual
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Provider Name | JAMIE PHILLIPICH PA
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Gender | Female
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Dates
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Enumeration Date | 12/29/2014
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Last Update Date | 12/29/2014
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Provider Practice Location Address
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Address Line | 1700 CLINTON ST
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City | MUSKEGON
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State | MI
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Zip | 49442-5502
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Country | US
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Telephone | 231-726-3511
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Fax |
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Provider Business Mailing Address
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Address Line | 125 COLLEGE AVE SE APT 5
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-4474
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Country | US
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Telephone | 517-505-2180
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 5601007253
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License Number State | MI
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