MEDICARE: MICHAEL WILLIAM LUTHER 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	5601003566	MI
2	363A00000X	Physician Assistant	PA19796	CA

General Provider Information

NPI Number	:	1447337688
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL WILLIAM LUTHER PA-C

Provider Business Mailing Address
First Line	:	26901 BEAUMONT BLVD STE 3D
Second Line	:
City	:	SOUTHFIELD
State	:	MI
Zip	:	48033-3849
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	44199 DEQUINDRE RD STE G-10
Second Line	:
City	:	TROY
State	:	MI
Zip	:	48085-1128
Country	:	US
Telephone Number	:	248-964-6111
Fax Number	:

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	04/14/2026

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