Provider Demographics
NPI:1013228840
Name:MAKI, MERCEDES A (PA)
Entity Type:Individual
Prefix:
First Name:MERCEDES
Middle Name:A
Last Name:MAKI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:MERCEDES
Other - Middle Name:A
Other - Last Name:LISCOMB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:500 CAMPUS DR
Mailing Address - Street 2:
Mailing Address - City:HANCOCK
Mailing Address - State:MI
Mailing Address - Zip Code:49930-1569
Mailing Address - Country:US
Mailing Address - Phone:906-483-1060
Mailing Address - Fax:906-372-3230
Practice Address - Street 1:500 CAMPUS DR
Practice Address - Street 2:
Practice Address - City:HANCOCK
Practice Address - State:MI
Practice Address - Zip Code:49930-1569
Practice Address - Country:US
Practice Address - Phone:906-483-1000
Practice Address - Fax:906-483-1103
Is Sole Proprietor?:No
Enumeration Date:2010-06-26
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601005726363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical