MEDICARE: MS. ANDREA ELISABETH MERCATANTE 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	5601009474	MI

General Provider Information

NPI Number	:	1548829658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANDREA ELISABETH MERCATANTE PA-C

Provider Business Mailing Address
First Line	:	19145 ALLEN RD STE 107
Second Line	:
City	:	BROWNSTOWN TWP
State	:	MI
Zip	:	48183-6812
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	19145 ALLEN RD STE 107
Second Line	:
City	:	BROWNSTOWN TWP
State	:	MI
Zip	:	48183-6812
Country	:	US
Telephone Number	:	734-486-4200
Fax Number	:

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

Provider Enumeration Date	:	06/12/2019
Last Update Date	:	09/18/2019

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