MEDICARE: MRS. MANDY JOAN GERMAN P.A.C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	5601004437	MI

General Provider Information

NPI Number	:	1023014982
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MANDY JOAN GERMAN P.A.C

Provider Business Mailing Address
First Line	:	100 MICHIGAN ST NE # MC845
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49503-2560
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1202 W OAK ST
Second Line	:
City	:	GREENVILLE
State	:	MI
Zip	:	48838-2155
Country	:	US
Telephone Number	:	616-754-2944
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2005
Last Update Date	:	02/26/2021

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