Provider Demographics
NPI:1376695445
Name:MICHELS, JOHN-DAVID GREAYER (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JOHN-DAVID
Middle Name:GREAYER
Last Name:MICHELS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3457 E AMBER LN
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-1838
Mailing Address - Country:US
Mailing Address - Phone:480-945-6016
Mailing Address - Fax:
Practice Address - Street 1:81 W GUADALUPE RD
Practice Address - Street 2:STE 111
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-3321
Practice Address - Country:US
Practice Address - Phone:480-366-4490
Practice Address - Fax:623-748-5774
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2415363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZP44233Medicare UPIN