MEDICARE: MR. RICHARD A CALL 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	5601004029	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1150910550	OTHER	MI	BCBS OF MICHIGAN

General Provider Information

NPI Number	:	1760424972
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RICHARD A CALL PA-C

Provider Business Mailing Address
First Line	:	1003 WOODSIDE AVE
Second Line	:
City	:	ESSEXVILLE
State	:	MI
Zip	:	48732-1234
Country	:	US
Telephone Number	:	989-892-7722
Fax Number	:	989-892-7455

Provider Business Practice Location Address
First Line	:	129 W BROWN ST
Second Line	:
City	:	BEAVERTON
State	:	MI
Zip	:	48612-8119
Country	:	US
Telephone Number	:	989-435-2937
Fax Number	:	989-435-3121

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

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	09/23/2013

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Directions to “ MR. RICHARD A CALL PA-C” Practice Location

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