Provider Demographics
NPI:1457934424
Name:BART-PLANGE, EMMANUEL JOHN IV (PA)
Entity type:Individual
Prefix:MR
First Name:EMMANUEL
Middle Name:JOHN
Last Name:BART-PLANGE
Suffix:IV
Gender:M
Credentials:PA
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Mailing Address - Street 1:3290 W BIG BEAVER RD
Mailing Address - Street 2:STE 150
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-2931
Mailing Address - Country:US
Mailing Address - Phone:248-792-6527
Mailing Address - Fax:248-792-9106
Practice Address - Street 1:25 MICHIGAN ST NE STE 6100
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-2561
Practice Address - Country:US
Practice Address - Phone:616-267-7900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-28
Last Update Date:2024-09-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI7968363A00000X
MI5601010541363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant