MEDICARE: MR. STEPHEN C JARVIS PA

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	5601003855	MI

General Provider Information

NPI Number	:	1265537245
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. STEPHEN C JARVIS PA

Provider Business Mailing Address
First Line	:	3252 UNIVERSITY DR
Second Line	:	STE 140
City	:	AUBURN HILLS
State	:	MI
Zip	:	48326-2782
Country	:	US
Telephone Number	:	248-373-7600
Fax Number	:	248-373-7714

Provider Business Practice Location Address
First Line	:	3252 UNIVERSITY DR
Second Line	:	STE 140
City	:	AUBURN HILLS
State	:	MI
Zip	:	48326-2782
Country	:	US
Telephone Number	:	248-373-7600
Fax Number	:	248-373-7714

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

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	07/08/2007

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