Provider Demographics
NPI:1396015905
Name:HIRDES, COREY J (PA-C)
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:J
Last Name:HIRDES
Suffix:
Gender:M
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 1:7169 KALAMAZOO AVE SE STE 100
Mailing Address - Street 2:
Mailing Address - City:CALEDONIA
Mailing Address - State:MI
Mailing Address - Zip Code:49316-8146
Mailing Address - Country:US
Mailing Address - Phone:616-266-9100
Mailing Address - Fax:616-266-9200
Practice Address - Street 1:7169 KALAMAZOO AVE SE STE 100
Practice Address - Street 2:
Practice Address - City:CALEDONIA
Practice Address - State:MI
Practice Address - Zip Code:49316
Practice Address - Country:US
Practice Address - Phone:616-266-9100
Practice Address - Fax:616-266-9200
Is Sole Proprietor?:No
Enumeration Date:2012-01-12
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5601006253363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant