Provider Demographics
NPI:1508822966
Name:PACK, MICHAEL A (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:PACK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:601 JOHN ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-5341
Mailing Address - Country:US
Mailing Address - Phone:269-373-1592
Mailing Address - Fax:269-373-6270
Practice Address - Street 1:601 JOHN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-5341
Practice Address - Country:US
Practice Address - Phone:269-373-1592
Practice Address - Fax:269-373-6270
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2023-11-27
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Provider Licenses
StateLicense IDTaxonomies
MI5101017554207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1417961137OtherBCBSM - BRONSON
MI1508822966Medicaid
MI1508822966OtherNPI
MI1417961137OtherBCBSM - BRONSON
MI0M99460Medicare PIN