Provider Demographics
NPI:1669296703
Name:LIGGETT, MADDISON JANE (PA)
Entity type:Individual
Prefix:MRS
First Name:MADDISON
Middle Name:JANE
Last Name:LIGGETT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:MADDISON
Other - Middle Name:
Other - Last Name:MEDLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 CAMPUS DRIVE
Mailing Address - Street 2:2015 JAMES H. ZUMBERGE HALL
Mailing Address - City:ALLENDALE
Mailing Address - State:MI
Mailing Address - Zip Code:49401-9403
Mailing Address - Country:US
Mailing Address - Phone:616-331-5700
Mailing Address - Fax:616-331-5999
Practice Address - Street 1:2200 DENDVINOS DRIVE
Practice Address - Street 2:SUITE 102
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684
Practice Address - Country:US
Practice Address - Phone:616-331-5700
Practice Address - Fax:616-331-5999
Is Sole Proprietor?:No
Enumeration Date:2024-11-14
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant