Provider Demographics
NPI:1295369718
Name:BRONSON, MELANIE J (PA-C)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:J
Last Name:BRONSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:559 W GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48216-2200
Mailing Address - Country:US
Mailing Address - Phone:313-554-0485
Mailing Address - Fax:313-228-0283
Practice Address - Street 1:17625 JOY RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48228-1999
Practice Address - Country:US
Practice Address - Phone:313-841-1699
Practice Address - Fax:313-554-1918
Is Sole Proprietor?:No
Enumeration Date:2020-02-24
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5601009562363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant