Provider Demographics
NPI:1528355856
Name:SIROIS, MICHAEL STEPHEN (PA-C)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:STEPHEN
Last Name:SIROIS
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:628 SALEM ST
Mailing Address - Street 2:LYNNFIELD PEDIATRICS
Mailing Address - City:LYNNFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01940-2340
Mailing Address - Country:US
Mailing Address - Phone:781-599-1998
Mailing Address - Fax:781-599-1221
Practice Address - Street 1:628 SALEM ST
Practice Address - Street 2:LYNNFIELD PEDIATRICS
Practice Address - City:LYNNFIELD
Practice Address - State:MA
Practice Address - Zip Code:01940-2340
Practice Address - Country:US
Practice Address - Phone:781-599-1998
Practice Address - Fax:781-599-1221
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-07
Last Update Date:2011-07-07
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Provider Licenses
StateLicense IDTaxonomies
MAPA4069363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant