MEDICARE: MICHAEL JOHN PLOCINIK 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	363AM0700X	Medical Physician Assistant	5601004489	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11468621	OTHER	MI	AETNA

General Provider Information

NPI Number	:	1528133451
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL JOHN PLOCINIK PA

Provider Business Mailing Address
First Line	:	80600 VAN DYKE RD
Second Line	:
City	:	BRUCE TWP
State	:	MI
Zip	:	48065-1333
Country	:	US
Telephone Number	:	810-798-6560
Fax Number	:	810-798-6563

Provider Business Practice Location Address
First Line	:	80600 VAN DYKE RD
Second Line	:
City	:	BRUCE TWP
State	:	MI
Zip	:	48065-1333
Country	:	US
Telephone Number	:	810-798-6560
Fax Number	:	810-798-6563

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

Provider Enumeration Date	:	11/24/2006
Last Update Date	:	11/23/2009

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Directions to “ MICHAEL JOHN PLOCINIK PA” Practice Location

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