Provider Demographics
NPI:1689626418
Name:AHERN, MICHAEL (PA-C)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:AHERN
Suffix:
Gender:M
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 1:6290 JUPITER AVE NE
Mailing Address - Street 2:SUITE A
Mailing Address - City:BELMONT
Mailing Address - State:MI
Mailing Address - Zip Code:49306-8884
Mailing Address - Country:US
Mailing Address - Phone:616-301-2500
Mailing Address - Fax:616-301-2501
Practice Address - Street 1:6290 JUPITER AVE NE
Practice Address - Street 2:SUITE A
Practice Address - City:BELMONT
Practice Address - State:MI
Practice Address - Zip Code:49306-8884
Practice Address - Country:US
Practice Address - Phone:616-301-2500
Practice Address - Fax:616-301-2501
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5601002931363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant