Provider Demographics
NPI:1659451250
Name:RAE, MELISSA JEANNE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:JEANNE
Last Name:RAE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:JEANNE
Other - Last Name:FOX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:31500 TELEGRAPH RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-4367
Mailing Address - Country:US
Mailing Address - Phone:248-723-6200
Mailing Address - Fax:248-723-6671
Practice Address - Street 1:31500 TELEGRAPH RD
Practice Address - Street 2:SUITE 220
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-4367
Practice Address - Country:US
Practice Address - Phone:248-723-6200
Practice Address - Fax:248-723-6671
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601004516363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant