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General NPI Number Information
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NPI Number | 1700852738
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Entity Type | Individual
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Provider Name | MICHAEL JOSEPH MCCARTHY PA-C
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Gender | Male
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Dates
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Enumeration Date | 02/28/2006
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Last Update Date | 04/07/2011
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Provider Practice Location Address
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Address Line | 4190 24TH AVE SUITE 206
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City | FORT GRATIOT
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State | MI
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Zip | 48059-3882
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Country | US
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Telephone | 810-989-7788
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Fax | 810-989-7799
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Provider Business Mailing Address
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Address Line | 3050 COMMERCE DR SUITE B
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City | FORT GRATIOT
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State | MI
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Zip | 48059-3819
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Country | US
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Telephone | 810-385-4441
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Fax | 810-385-1540
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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 | 5601001438
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License Number State | MI
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