Provider Demographics
NPI:1396012829
Name:ZERWAS, MELISSA KATHERINE (PA-C)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:KATHERINE
Last Name:ZERWAS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:KATHERINE
Other - Last Name:DICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:8896 COMMERCE RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:COMMERCE TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48382-4494
Mailing Address - Country:US
Mailing Address - Phone:248-360-9241
Mailing Address - Fax:248-360-0830
Practice Address - Street 1:8896 COMMERCE RD
Practice Address - Street 2:SUITE 5
Practice Address - City:COMMERCE TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48382-4494
Practice Address - Country:US
Practice Address - Phone:248-360-9241
Practice Address - Fax:248-360-0830
Is Sole Proprietor?:No
Enumeration Date:2011-11-29
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601006210363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant