MEDICARE: SETH VINCENT

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	5601011886	MI

General Provider Information

NPI Number	:	1699407189
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SETH VINCENT

Provider Business Mailing Address
First Line	:	8475 SKIFF LAKE RD
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49201-8369
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8475 SKIFF LAKE RD
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49201-8369
Country	:	US
Telephone Number	:	517-499-8803
Fax Number	:

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

Provider Enumeration Date	:	06/24/2022
Last Update Date	:	07/06/2023

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Directions to “ SETH VINCENT ” Practice Location

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