Provider Demographics
NPI:1891768065
Name:LOH, PAUL (PA-C)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:LOH
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 1:100 MICHIGAN ST NE, MC 103
Mailing Address - Street 2:SUITE 8830
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:616-459-7258
Mailing Address - Fax:616-459-5215
Practice Address - Street 1:100 MICHIGAN ST NE, MC 103
Practice Address - Street 2:SUITE 8830
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-2560
Practice Address - Country:US
Practice Address - Phone:616-459-7258
Practice Address - Fax:616-459-5215
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601001939363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N54220007Medicare ID - Type Unspecified
MIP00641Medicare UPIN