Provider Demographics
NPI:1770927717
Name:MICHAEL, ANN MARIE (PA)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:MARIE
Last Name:MICHAEL
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-343-9800
Mailing Address - Fax:704-347-2011
Practice Address - Street 1:4622 COUNTRY CLUB RD STE 180
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27104-3770
Practice Address - Country:US
Practice Address - Phone:336-768-9535
Practice Address - Fax:336-768-4155
Is Sole Proprietor?:No
Enumeration Date:2013-04-22
Last Update Date:2023-07-10
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Provider Licenses
StateLicense IDTaxonomies
NC001003907363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant