Provider Demographics
NPI:1891806337
Name:THEURER, DAVID RICHARD (PAC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:RICHARD
Last Name:THEURER
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2770 MAIN ST
Mailing Address - Street 2:ACUTE CARE
Mailing Address - City:MARLETTE
Mailing Address - State:MI
Mailing Address - Zip Code:48453-1141
Mailing Address - Country:US
Mailing Address - Phone:989-635-4100
Mailing Address - Fax:939-635-4035
Practice Address - Street 1:2770 MAIN ST
Practice Address - Street 2:ACUTE CARE
Practice Address - City:MARLETTE
Practice Address - State:MI
Practice Address - Zip Code:48453-1141
Practice Address - Country:US
Practice Address - Phone:989-635-4100
Practice Address - Fax:939-635-4035
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601001581363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI5159003Medicare PIN
MIR66602Medicare UPIN
MI0G66003-174Medicare ID - Type Unspecified