MEDICARE: MICHELLE LYNN HABETS 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
1	363A00000X	Physician Assistant	003773	MI
2	363A00000X	Physician Assistant	PA23308	CA

General Provider Information

NPI Number	:	1558387936
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE LYNN HABETS P.A.

Provider Business Mailing Address
First Line	:	9179 FALCON RIDGE LN
Second Line	:
City	:	FAIR OAKS
State	:	CA
Zip	:	95628-6597
Country	:	US
Telephone Number	:	734-904-5410
Fax Number	:	310-954-9373

Provider Business Practice Location Address
First Line	:	8067 HIDDEN VIEW CIR
Second Line	:
City	:	FAIR OAKS
State	:	CA
Zip	:	95628-5965
Country	:	US
Telephone Number	:	734-904-5410
Fax Number	:

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

Provider Enumeration Date	:	07/15/2006
Last Update Date	:	06/10/2018

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