Provider Demographics
NPI:1346885910
Name:GARMO, MERISSA MAY (PA-C)
Entity Type:Individual
Prefix:
First Name:MERISSA
Middle Name:MAY
Last Name:GARMO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30880 BECK RD
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377-1000
Mailing Address - Country:US
Mailing Address - Phone:248-926-0009
Mailing Address - Fax:248-956-9198
Practice Address - Street 1:30880 BECK RD
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377-1000
Practice Address - Country:US
Practice Address - Phone:248-926-0009
Practice Address - Fax:248-956-9198
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-07
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601009781363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5601009781OtherPHYSICIAN ASSISTANT LICENSE