Provider Demographics
NPI:1275768392
Name:TOBICZYK, MEGHAN HALEY ALICE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:MEGHAN
Middle Name:HALEY ALICE
Last Name:TOBICZYK
Suffix:
Gender:F
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 1:28903 WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:BERKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48072-0924
Mailing Address - Country:US
Mailing Address - Phone:248-581-0333
Mailing Address - Fax:810-230-0014
Practice Address - Street 1:28903 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:BERKLEY
Practice Address - State:MI
Practice Address - Zip Code:48072-0924
Practice Address - Country:US
Practice Address - Phone:248-581-0333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-19
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601006001363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHDD1846OtherRAILROAD GROUP
OH9344881OtherMEDICARE GROUP
OH9344881OtherMEDICARE GROUP