Provider Demographics
NPI:1710432646
Name:LUPO, MICHAEL MATTHEW (PA-C)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:MATTHEW
Last Name:LUPO
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 1:3884 MONITOR RD
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-9298
Mailing Address - Country:US
Mailing Address - Phone:989-671-2000
Mailing Address - Fax:
Practice Address - Street 1:3884 MONITOR RD
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-9298
Practice Address - Country:US
Practice Address - Phone:989-671-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-21
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant