MEDICARE: GLORIA JEAN PADILLA-CARLSON 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	363A00000X	Physician Assistant	5601005122	MI

General Provider Information

NPI Number	:	1275500399
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLORIA JEAN PADILLA-CARLSON PA-C

Provider Business Mailing Address
First Line	:	600 S LINCOLN ST
Second Line	:
City	:	AUGUSTA
State	:	MI
Zip	:	49012-9758
Country	:	US
Telephone Number	:	269-731-5762
Fax Number	:	269-731-5764

Provider Business Practice Location Address
First Line	:	600 S LINCOLN ST
Second Line	:
City	:	AUGUSTA
State	:	MI
Zip	:	49012-9758
Country	:	US
Telephone Number	:	269-731-5762
Fax Number	:	269-731-5764

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

Provider Enumeration Date	:	03/07/2006
Last Update Date	:	07/17/2013

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Directions to “ GLORIA JEAN PADILLA-CARLSON PA-C” Practice Location

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