Provider Demographics
NPI:1144208067
Name:LEXMOND, MICHELLE E (PA)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:E
Last Name:LEXMOND
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 220
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-0220
Mailing Address - Country:US
Mailing Address - Phone:888-674-0854
Mailing Address - Fax:906-225-3370
Practice Address - Street 1:4602 DEPT
Practice Address - Street 2:
Practice Address - City:CAROL STREAM
Practice Address - State:IL
Practice Address - Zip Code:60122-4602
Practice Address - Country:US
Practice Address - Phone:906-225-3630
Practice Address - Fax:906-225-4537
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601003539363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5601003539OtherMICHIGAN LICENSE NUMBER
MI5601003539OtherMICHIGAN LICENSE NUMBER