Provider Demographics
NPI:1093139982
Name:PAIL, JAMES (PAC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:PAIL
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2610 E HURLEY RD
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48642-7376
Mailing Address - Country:US
Mailing Address - Phone:989-948-4799
Mailing Address - Fax:
Practice Address - Street 1:863 N PINE RD STE F
Practice Address - Street 2:
Practice Address - City:ESSEXVILLE
Practice Address - State:MI
Practice Address - Zip Code:48732-2159
Practice Address - Country:US
Practice Address - Phone:989-948-4799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-12
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI999999999363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP43930017Medicare PIN
MIE66019095Medicare PIN
MIZ96017104Medicare PIN