Provider Demographics
NPI:1588222830
Name:TICE, AARON JAMES (PA-C)
Entity type:Individual
Prefix:
First Name:AARON
Middle Name:JAMES
Last Name:TICE
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 1:13073 CLINTON RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MI
Mailing Address - Zip Code:49236-9629
Mailing Address - Country:US
Mailing Address - Phone:517-442-5765
Mailing Address - Fax:
Practice Address - Street 1:44199 DEQUINDRE RD STE 315
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48085-1128
Practice Address - Country:US
Practice Address - Phone:248-964-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-02
Last Update Date:2019-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601009435APP192086S0127X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery