Provider Demographics
NPI:1437463734
Name:KWAYKE, MICHEEL (PA)
Entity Type:Individual
Prefix:MISS
First Name:MICHEEL
Middle Name:
Last Name:KWAYKE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31575 WINTERPLACE PKWY
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-1882
Mailing Address - Country:US
Mailing Address - Phone:410-546-0900
Mailing Address - Fax:410-546-4976
Practice Address - Street 1:31575 WINTERPLACE PKWY
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-1882
Practice Address - Country:US
Practice Address - Phone:410-546-0900
Practice Address - Fax:410-546-4976
Is Sole Proprietor?:No
Enumeration Date:2010-07-29
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0004243363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant