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General NPI Number Information
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NPI Number | 1811776669
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Entity Type | Individual
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Provider Name | MICHAEL MAHER PA-C
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Gender | Male
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Dates
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Enumeration Date | 09/21/2023
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Last Update Date | 09/21/2023
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Provider Practice Location Address
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Address Line | 9697 SAINT CATHERINES DR # 200
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City | PLEASANT PRAIRIE
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State | WI
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Zip | 53158-2118
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Country | US
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Telephone | 262-577-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 17425 SUMMIT VIEW PLACE LN
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City | WILDWOOD
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State | MO
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Zip | 63038-2106
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Country | US
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Telephone | 314-707-2504
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 7641-23
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License Number State | WI
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