Provider Demographics
NPI:1316455215
Name:KING, MELISSA COURTNEY (PA-C)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:COURTNEY
Last Name:KING
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:COURTNEY
Other - Last Name:GASIOREK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:22250 PROVIDENCE DR STE 705
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-6215
Mailing Address - Country:US
Mailing Address - Phone:248-465-5955
Mailing Address - Fax:248-465-4864
Practice Address - Street 1:47601 GRAND RIVER AVE STE C202
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48374-1204
Practice Address - Country:US
Practice Address - Phone:248-465-5955
Practice Address - Fax:248-465-4864
Is Sole Proprietor?:No
Enumeration Date:2018-01-14
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical