Registry details
Type
Individual
Primary specialty
Physician Assistant, Medical
Enumerated
Jul 5, 2017
License(s)
5601008222 (MI)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 24 FRANK LLOYD WRIGHT DR LBBY J | Ann Arbor, MI 48105-9484 | 734-747-6766 |
| LOCATION | 5301 E HURON RIVER DR | Ypsilanti, MI 48197-1051 | 734-712-8676 |
Watch this provider
Get a webhook/email the day this provider is added to the OIG-LEIE exclusion list or appears in an FDA enforcement action.