MEDICARE: MRS. MICHELLE E LEXMOND P.A.

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	5601003539	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5601003539	OTHER	MI	MICHIGAN LICENSE NUMBER

General Provider Information

NPI Number	:	1144208067
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MICHELLE E LEXMOND P.A.

Provider Business Mailing Address
First Line	:	PO BOX 220
Second Line	:
City	:	MARQUETTE
State	:	MI
Zip	:	49855-0220
Country	:	US
Telephone Number	:	888-674-0854
Fax Number	:	906-225-3370

Provider Business Practice Location Address
First Line	:	4602 DEPT
Second Line	:
City	:	CAROL STREAM
State	:	IL
Zip	:	60122-4602
Country	:	US
Telephone Number	:	906-225-3630
Fax Number	:	906-225-4537

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

Provider Enumeration Date	:	01/03/2006
Last Update Date	:	09/16/2009

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