Provider Demographics
NPI:1518627843
Name:ASHENFELTER, ANDREW CONRAD (PA-C)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:CONRAD
Last Name:ASHENFELTER
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 1:13740 SHIRE RD
Mailing Address - Street 2:
Mailing Address - City:WOLVERINE
Mailing Address - State:MI
Mailing Address - Zip Code:49799-9302
Mailing Address - Country:US
Mailing Address - Phone:231-833-0232
Mailing Address - Fax:
Practice Address - Street 1:825 N CENTER AVE
Practice Address - Street 2:
Practice Address - City:GAYLORD
Practice Address - State:MI
Practice Address - Zip Code:49735-1592
Practice Address - Country:US
Practice Address - Phone:897-312-1009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-28
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601010948TMP21363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant