Provider Demographics
NPI:1215699319
Name:EMERY, MICHAEL LEONARD (PA-C)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LEONARD
Last Name:EMERY
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 1:4562 WINKLER AVE APT 106
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33966-7021
Mailing Address - Country:US
Mailing Address - Phone:954-534-1459
Mailing Address - Fax:
Practice Address - Street 1:14192 METROPOLIS AVE
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4331
Practice Address - Country:US
Practice Address - Phone:239-245-8223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-06
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical