MEDICARE: MS. PEARL DUA 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	363AM0700X	Medical Physician Assistant	5601004694	MI
2	363A00000X	Physician Assistant	5601004694	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5601004694	OTHER	MI	LICENSE NUMBER

General Provider Information

NPI Number	:	1902837677
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PEARL DUA P.A.

Provider Business Mailing Address
First Line	:	35735 MOUND RD STE 100
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-4728
Country	:	US
Telephone Number	:	586-261-1960
Fax Number	:	586-261-1961

Provider Business Practice Location Address
First Line	:	35735 MOUND RD STE 100
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-4728
Country	:	US
Telephone Number	:	586-261-1960
Fax Number	:	586-261-1961

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

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	06/11/2024

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