Provider Demographics
NPI:1427058015
Name:LEPISTO, JOHN G JR (PA-C)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:G
Last Name:LEPISTO
Suffix:JR
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:5251 CLYDE PARK AVE SW
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49509-9522
Mailing Address - Country:US
Mailing Address - Phone:616-532-1100
Mailing Address - Fax:616-249-2246
Practice Address - Street 1:5251 CLYDE PARK AVE SW
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49509-9522
Practice Address - Country:US
Practice Address - Phone:616-532-1100
Practice Address - Fax:616-249-2246
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5601001818363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical