Provider Demographics
NPI:1508896523
Name:CHIMO, CATHERINE MARIE (PA)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:MARIE
Last Name:CHIMO
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:PO BOX 994
Mailing Address - Street 2:
Mailing Address - City:ALMA
Mailing Address - State:MI
Mailing Address - Zip Code:48801-0994
Mailing Address - Country:US
Mailing Address - Phone:989-466-7188
Mailing Address - Fax:989-463-0663
Practice Address - Street 1:820 N PINE RIVER ST
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:MI
Practice Address - Zip Code:48847-1118
Practice Address - Country:US
Practice Address - Phone:989-875-3722
Practice Address - Fax:989-875-8903
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601001489363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0852915050OtherBCBSM
MIP13710004Medicare PIN
MIS54361Medicare UPIN
MIM02890P14Medicare PIN
MI0852915050OtherBCBSM
MIM17400025Medicare PIN