Provider Demographics
NPI:1619419553
Name:SCHWEITZER, ERICA ELLEN (PA-C)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:ELLEN
Last Name:SCHWEITZER
Suffix:
Gender:F
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 1:2021 SWARANNE DR
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48324-1057
Mailing Address - Country:US
Mailing Address - Phone:734-678-6465
Mailing Address - Fax:
Practice Address - Street 1:4701 SAINT ANTOINE ST STE E-510
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-1428
Practice Address - Country:US
Practice Address - Phone:313-993-2966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-09
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601007964363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant