Provider Demographics
NPI:1528150893
Name:CLAUSSEN, MICHAEL MAURICE (PA-C)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:MAURICE
Last Name:CLAUSSEN
Suffix:
Gender:M
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 1:3200 W CENTRE AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-4889
Mailing Address - Country:US
Mailing Address - Phone:269-324-0799
Mailing Address - Fax:269-324-8013
Practice Address - Street 1:3200 W CENTRE ST
Practice Address - Street 2:SUITE 203
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024
Practice Address - Country:US
Practice Address - Phone:269-381-7380
Practice Address - Fax:269-341-4562
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIM5601002134363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN9464001Medicare ID - Type Unspecified