Provider Demographics
NPI:1538140751
Name:FLEMING, PAMELA J (PA-C)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:J
Last Name:FLEMING
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:100 MICHIGAN ST NE # MC845
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:616-486-6790
Mailing Address - Fax:
Practice Address - Street 1:300 N PATTERSON RD
Practice Address - Street 2:
Practice Address - City:REED CITY
Practice Address - State:MI
Practice Address - Zip Code:49677-8041
Practice Address - Country:US
Practice Address - Phone:231-832-7170
Practice Address - Fax:231-832-9554
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2015-10-27
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Provider Licenses
StateLicense IDTaxonomies
MI5601001190363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0F76001Medicare PIN