Provider Demographics
NPI:1285773671
Name:THWAITES, BRIAN D (PA-C)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:D
Last Name:THWAITES
Suffix:
Gender:M
Credentials:PA-C
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Other - Credentials:
Mailing Address - Street 1:301 N MAIN ST
Mailing Address - Street 2:P.O BOX 155
Mailing Address - City:SHERIDAN
Mailing Address - State:MI
Mailing Address - Zip Code:48884-9235
Mailing Address - Country:US
Mailing Address - Phone:989-291-6264
Mailing Address - Fax:989-291-5350
Practice Address - Street 1:303 CONGRESS ST
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:MI
Practice Address - Zip Code:48884-9215
Practice Address - Country:US
Practice Address - Phone:989-291-5077
Practice Address - Fax:989-291-4348
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2021-11-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5601003377363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP53420Medicare UPIN
MIN83930001Medicare PIN