MEDICARE: MICHELLE L PLUMB 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	5601003734	MI
2	363A00000X	Physician Assistant	5601003734	MI

General Provider Information

NPI Number	:	1982699872
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE L PLUMB PA-C

Provider Business Mailing Address
First Line	:	26901 BEAUMONT BLVD # 3D
Second Line	:
City	:	SOUTHFIELD
State	:	MI
Zip	:	48033-3849
Country	:	US
Telephone Number	:	947-522-4352
Fax Number	:

Provider Business Practice Location Address
First Line	:	18101 OAKWOOD BLVD
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48124-4089
Country	:	US
Telephone Number	:	313-593-7000
Fax Number	:

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

Provider Enumeration Date	:	09/16/2005
Last Update Date	:	09/17/2024

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