MEDICARE: MR. STEPHEN PAUL DUCHEMIN 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	363AM0700X	Medical Physician Assistant	5601001567	MI

General Provider Information

NPI Number	:	1902805104
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. STEPHEN PAUL DUCHEMIN PA-C

Provider Business Mailing Address
First Line	:	5340 CHRISTIE AVE SE
Second Line	:
City	:	KENTWOOD
State	:	MI
Zip	:	49508-6163
Country	:	US
Telephone Number	:	616-455-7849
Fax Number	:

Provider Business Practice Location Address
First Line	:	2680 LEONARD ST NW
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49504-3760
Country	:	US
Telephone Number	:	616-224-1515
Fax Number	:	616-224-2070

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

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	07/08/2007

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