Provider Demographics
NPI:1598210544
Name:BROEKHUIZEN, MORGAN (PA)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:
Last Name:BROEKHUIZEN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:MORGAN
Other - Middle Name:
Other - Last Name:LUSK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:24 FRANK LLOYD WRIGHT DR.
Mailing Address - Street 2:LOBBY J2000
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48106
Mailing Address - Country:US
Mailing Address - Phone:734-593-5700
Mailing Address - Fax:734-593-5705
Practice Address - Street 1:14650 E. OLD US HWY 12
Practice Address - Street 2:SUITE 105
Practice Address - City:CHELSEA
Practice Address - State:MI
Practice Address - Zip Code:48118
Practice Address - Country:US
Practice Address - Phone:734-593-5700
Practice Address - Fax:734-593-5705
Is Sole Proprietor?:No
Enumeration Date:2016-08-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601007850363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant