Provider Demographics
NPI:1760424972
Name:CALL, RICHARD A (PA-C)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:A
Last Name:CALL
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 1:1003 WOODSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:ESSEXVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48732-1234
Mailing Address - Country:US
Mailing Address - Phone:989-892-7722
Mailing Address - Fax:989-892-7455
Practice Address - Street 1:129 W BROWN ST
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:MI
Practice Address - Zip Code:48612-8119
Practice Address - Country:US
Practice Address - Phone:989-435-2937
Practice Address - Fax:989-435-3121
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601004029363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1150910550OtherBCBS OF MICHIGAN
MIZ96017102Medicare PIN
MIE66019093Medicare PIN
MIMI1118006Medicare UPIN
MIMI1118Medicare UPIN
P84906Medicare UPIN
MI0N1180003Medicare ID - Type Unspecified
MIP43930016Medicare PIN