Provider Demographics
NPI:1639230378
Name:STEELE, JEREMY M (PA)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:M
Last Name:STEELE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:100 MALTON ST
Mailing Address - Street 2:STE 4
Mailing Address - City:NEGAUNEE
Mailing Address - State:MI
Mailing Address - Zip Code:49866-2001
Mailing Address - Country:US
Mailing Address - Phone:906-475-7838
Mailing Address - Fax:906-486-6898
Practice Address - Street 1:100 MALTON ST
Practice Address - Street 2:STE 4
Practice Address - City:NEGAUNEE
Practice Address - State:MI
Practice Address - Zip Code:49866-2001
Practice Address - Country:US
Practice Address - Phone:906-475-7838
Practice Address - Fax:906-486-6898
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5601004409363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIQ46083Medicare UPIN
MI0P18200001Medicare ID - Type Unspecified