Provider Demographics
NPI:1356452098
Name:EMOND, JOHN A (PA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:EMOND
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1003 WOODSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:ESSEXVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48732-1234
Mailing Address - Country:US
Mailing Address - Phone:989-892-7722
Mailing Address - Fax:989-892-7722
Practice Address - Street 1:1458 W CENTER RD
Practice Address - Street 2:SUITE 2
Practice Address - City:ESSEXVILLE
Practice Address - State:MI
Practice Address - Zip Code:48732-2151
Practice Address - Country:US
Practice Address - Phone:989-895-4860
Practice Address - Fax:989-895-4862
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5601001253363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIE66019091Medicare PIN
MIZ96017100Medicare PIN
MI0M83800Medicare ID - Type Unspecified
MIP43930014Medicare PIN
MIS37395Medicare UPIN