Provider Demographics
NPI:1194174821
Name:BECKERICH, MEGAN CATHERINE (PA-C)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:CATHERINE
Last Name:BECKERICH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:CATHERINE
Other - Last Name:BRAGG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:22487 BOULDER AVE
Mailing Address - Street 2:
Mailing Address - City:EASTPOINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48021-2305
Mailing Address - Country:US
Mailing Address - Phone:586-255-9290
Mailing Address - Fax:
Practice Address - Street 1:19070 E 10 MILE RD
Practice Address - Street 2:
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021-1449
Practice Address - Country:US
Practice Address - Phone:313-923-7501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-03
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601007806363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant