Provider Demographics
NPI:1700852738
Name:MCCARTHY, MICHAEL JOSEPH (PA-C)
Entity Type:Individual
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First Name:MICHAEL
Middle Name:JOSEPH
Last Name:MCCARTHY
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:3050 COMMERCE DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:FORT GRATIOT
Mailing Address - State:MI
Mailing Address - Zip Code:48059-3819
Mailing Address - Country:US
Mailing Address - Phone:810-385-4441
Mailing Address - Fax:810-385-1540
Practice Address - Street 1:4190 24TH AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:FORT GRATIOT
Practice Address - State:MI
Practice Address - Zip Code:48059-3882
Practice Address - Country:US
Practice Address - Phone:810-989-7788
Practice Address - Fax:810-989-7799
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2011-04-07
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Provider Licenses
StateLicense IDTaxonomies
MI5601001438363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant