MEDICARE: MICHAEL A GATES PA-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	363AM0700X	Medical Physician Assistant	MA001660L	PA

General Provider Information

NPI Number	:	1043235179
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL A GATES PA-C

Provider Business Mailing Address
First Line	:	PO BOX 1549
Second Line	:
City	:	BUTLER
State	:	PA
Zip	:	16003-1549
Country	:	US
Telephone Number	:	724-284-4060
Fax Number	:	724-284-4144

Provider Business Practice Location Address
First Line	:	127 ONEIDA VALLEY RD
Second Line	:	SUITE 202
City	:	BUTLER
State	:	PA
Zip	:	16001-2252
Country	:	US
Telephone Number	:	866-620-6761
Fax Number	:	724-282-3043

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

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	11/23/2016

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