Provider Demographics
NPI:1407002520
Name:MICHAEL, CAITLIN ELIZABETH (PA-C)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:ELIZABETH
Last Name:MICHAEL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 HANSEN DR
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-3304
Mailing Address - Country:US
Mailing Address - Phone:610-883-3736
Mailing Address - Fax:
Practice Address - Street 1:5700 ARNOLD ST
Practice Address - Street 2:72MDG/SGOL
Practice Address - City:TINKER AFB
Practice Address - State:OK
Practice Address - Zip Code:73145-8105
Practice Address - Country:US
Practice Address - Phone:405-736-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-08
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA053455363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical