Provider Demographics
NPI:1366473084
Name:JAMES, MICHAEL MAX (PA)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:MAX
Last Name:JAMES
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 769
Mailing Address - Street 2:
Mailing Address - City:MANCELONA
Mailing Address - State:MI
Mailing Address - Zip Code:49659-0769
Mailing Address - Country:US
Mailing Address - Phone:231-587-9181
Mailing Address - Fax:231-587-0923
Practice Address - Street 1:419 W STATE ST.
Practice Address - Street 2:
Practice Address - City:MANCELONA
Practice Address - State:MI
Practice Address - Zip Code:49659
Practice Address - Country:US
Practice Address - Phone:231-587-9181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601001224363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant