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NPI Code Detail

MEDICARE: STUART NATHAN P.A.

MEDICARE: STUART NATHAN 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
1363A00000XPhysician Assistant5601002706MI

General Provider Information

NPI Number : 1407836869
Entity Type Code : Individual
Provider Name (Legal Business Name) : STUART NATHAN P.A.
Provider Business Mailing Address
First Line : 36123 SCHOOLCRAFT RD
Second Line :
City : LIVONIA
State : MI
Zip : 48150-1216
Country : US
Telephone Number : 734-464-0887
Fax Number : 734-402-0254
Provider Business Practice Location Address
First Line : 8365 N NEWBURGH RD
Second Line :
City : WESTLAND
State : MI
Zip : 48185-1149
Country : US
Telephone Number : 734-464-0887
Fax Number : 734-402-0254
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/20/2006
Last Update Date : 09/15/2015

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