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NPI Code Detail

MEDICARE: BETH MACK GENTNER P.A.-C

MEDICARE: BETH MACK GENTNER P.A.-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
1363A00000XPhysician Assistant5601002066MI

General Provider Information

NPI Number : 1457328833
Entity Type Code : Individual
Provider Name (Legal Business Name) : BETH MACK GENTNER P.A.-C
Provider Business Mailing Address
First Line : 5163 E HOLLY RD
Second Line :
City : HOLLY
State : MI
Zip : 48442-9746
Country : US
Telephone Number : 248-634-8840
Fax Number :
Provider Business Practice Location Address
First Line : 102 N ADELAIDE ST
Second Line :
City : FENTON
State : MI
Zip : 48430-2670
Country : US
Telephone Number : 810-629-2245
Fax Number : 810-629-6535
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/03/2006
Last Update Date : 01/07/2009

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Directions to “ BETH MACK GENTNER P.A.-C” Practice Location

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