Provider Demographics
NPI:1811074065
Name:SCHMELZER, DEBRA ANN (PA-C)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:ANN
Last Name:SCHMELZER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:ANN
Other - Last Name:HILL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:2115 N DAMEN AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-4528
Mailing Address - Country:US
Mailing Address - Phone:773-697-3144
Mailing Address - Fax:
Practice Address - Street 1:555 HORACE BROWN DR
Practice Address - Street 2:SUITE 200
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-1867
Practice Address - Country:US
Practice Address - Phone:773-697-3144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601003840363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1437577061OtherNPI GROUP PRACTICE