Provider Demographics
NPI:1194731034
Name:CONTE, MICHAEL JOHN (PA-C)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JOHN
Last Name:CONTE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:MICHAEL
Other - Middle Name:J
Other - Last Name:CONTE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:875 BLAKE WILBUR DR
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94304-2205
Mailing Address - Country:US
Mailing Address - Phone:650-498-6000
Mailing Address - Fax:
Practice Address - Street 1:875 BLAKE WILBUR DR
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-2205
Practice Address - Country:US
Practice Address - Phone:650-498-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2018-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10369363A00000X
CA55048363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN799405000Medicaid