Provider Demographics
NPI:1801242359
Name:ANCEL, ADAM (MS ATC PA-S)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:ANCEL
Suffix:
Gender:M
Credentials:MS ATC PA-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2375 SUMMIT PARK DR
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-8685
Mailing Address - Country:US
Mailing Address - Phone:231-348-3283
Mailing Address - Fax:231-348-3331
Practice Address - Street 1:2375 SUMMIT PARK DR
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-8685
Practice Address - Country:US
Practice Address - Phone:231-348-3283
Practice Address - Fax:231-348-3331
Is Sole Proprietor?:No
Enumeration Date:2016-05-13
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5601007791208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation