Provider Demographics
NPI:1740911270
Name:PERSYN, ALEXANDER ZACHARY (PA-C)
Entity type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:ZACHARY
Last Name:PERSYN
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 1:4205 S ISABELLA RD
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-9103
Mailing Address - Country:US
Mailing Address - Phone:810-748-7003
Mailing Address - Fax:
Practice Address - Street 1:4205 S ISABELLA RD
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-9103
Practice Address - Country:US
Practice Address - Phone:810-748-7003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-24
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601011259363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant