Provider Demographics
NPI:1013039676
Name:COASTER, MICHELLE (PA-C)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:COASTER
Suffix:
Gender:F
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 1:2852 EYDE PKWY
Mailing Address - Street 2:SUITE 175
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-5378
Mailing Address - Country:US
Mailing Address - Phone:517-333-4600
Mailing Address - Fax:517-333-4996
Practice Address - Street 1:2852 EYDE PKWY
Practice Address - Street 2:SUITE 175
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-5378
Practice Address - Country:US
Practice Address - Phone:517-333-4600
Practice Address - Fax:517-333-4996
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMC004387363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIQ27238Medicare UPIN