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NPI Code Detail

MEDICARE: MRS. TARA MELISSA WAY PA-C

MEDICARE: MRS. TARA MELISSA WAY 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
1363A00000XPhysician AssistantMI

General Provider Information

NPI Number : 1558611491
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. TARA MELISSA WAY PA-C
Provider Business Mailing Address
First Line : 34841 VETERANS PLZ
Second Line :
City : WAYNE
State : MI
Zip : 48184-1733
Country : US
Telephone Number : 734-728-3446
Fax Number :
Provider Business Practice Location Address
First Line : 34841 VETERANS PLZ
Second Line :
City : WAYNE
State : MI
Zip : 48184-1733
Country : US
Telephone Number : 734-728-3446
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/18/2012
Last Update Date : 11/21/2014

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Directions to “ MRS. TARA MELISSA WAY PA-C” Practice Location

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