Michael James Church, PA-C
Physician Assistant in Kenosha, WI. Individual provider (NPI-1).
NPI number1164056727
StatusActive
Last updated in NPPESSep 2, 2020
Details
- NPI
- 1164056727
- Entity type
- Individual (NPI-1)
- Name
- Michael James Church
- Credential
- PA-C
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Feb 23, 2020
- Certification date
- Sep 2, 2020
- Last updated
- Sep 2, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363A00000X | Physician Assistant | 5119-23 | WI | Yes |
| 390200000X | Student in an Organized Health Care Education/Training Program | – | – | |
| 363AM0700X | Physician Assistant, Medical | 5119-23 | WI |
Practice location
6308 8th AveKenosha, WI 53143-5031
Phone 262-656-2011
Mailing address
3108 Market Ln Apt 804Kenosha, WI 53144-3463
Phone 616-295-5062
Other practice locations
636 Manhattan Rd Se
Grand Rapids, MI 49506-2025
Grand Rapids, MI 49506-2025
Phone 616-295-5062
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