Provider Demographics
NPI:1821284951
Name:STREU, MICHELLE GRACE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:GRACE
Last Name:STREU
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:GRACE
Other - Last Name:JIBOWU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:24 FRANK LLOYD WRIGHT DR LBBY J2000
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-9484
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6869 OCCIDENTAL HWY
Practice Address - Street 2:
Practice Address - City:TECUMSEH
Practice Address - State:MI
Practice Address - Zip Code:49286
Practice Address - Country:US
Practice Address - Phone:517-423-4777
Practice Address - Fax:517-423-7257
Is Sole Proprietor?:No
Enumeration Date:2007-09-21
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601005084363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP01012709OtherRR MEDICARE
MI1821284951Medicaid
MIP01012709OtherRR MEDICARE