Provider Demographics
NPI:1073645883
Name:JAMES, MICHELLE LYNN (PA-C)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LYNN
Last Name:JAMES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:LYNN
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3401 ENTERPRISE PKWY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-7341
Mailing Address - Country:US
Mailing Address - Phone:216-831-5700
Mailing Address - Fax:216-831-1959
Practice Address - Street 1:3401 ENTERPRISE PKWY
Practice Address - Street 2:SUITE 300
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-7341
Practice Address - Country:US
Practice Address - Phone:216-831-5700
Practice Address - Fax:216-831-1959
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1076518363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
1076518OtherCERT. OF PHYS. ASST.
OHRP860991OtherDRIVER'S LICENSE