Provider Demographics
NPI:1508913047
Name:FRANCOEUR, SUZY JO (PA)
Entity Type:Individual
Prefix:
First Name:SUZY
Middle Name:JO
Last Name:FRANCOEUR
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 1:40000 GRAND RIVER AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-2133
Mailing Address - Country:US
Mailing Address - Phone:248-478-1616
Mailing Address - Fax:
Practice Address - Street 1:40000 GRAND RIVER AVE STE 105
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-2133
Practice Address - Country:US
Practice Address - Phone:248-478-1616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2009-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601004813363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1503037Medicare UPIN
MI1504037Medicare UPIN
MIMI1503Medicare PIN
MIMI1504Medicare PIN