Provider Demographics
NPI:1194058081
Name:STEPHANIDES, MICHAEL MILLER (PA-C)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:MILLER
Last Name:STEPHANIDES
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:301 LINVILLE ST
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-7206
Mailing Address - Country:US
Mailing Address - Phone:828-584-2481
Mailing Address - Fax:828-584-8371
Practice Address - Street 1:301 LINVILLE ST
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-7206
Practice Address - Country:US
Practice Address - Phone:828-584-2481
Practice Address - Fax:828-584-8371
Is Sole Proprietor?:No
Enumeration Date:2009-09-10
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC100766363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant