Provider Demographics
NPI:1558054031
Name:MICEK, MEGAN CAROLINE (PA-C)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:CAROLINE
Last Name:MICEK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:103 ALLEN ST
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-6968
Mailing Address - Country:US
Mailing Address - Phone:716-338-0022
Mailing Address - Fax:716-338-1567
Practice Address - Street 1:103 ALLEN ST
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-6968
Practice Address - Country:US
Practice Address - Phone:716-338-0022
Practice Address - Fax:716-338-1567
Is Sole Proprietor?:No
Enumeration Date:2023-05-31
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant