Provider Demographics
NPI:1982934022
Name:SISITKI, ALEAH M (PA-C)
Entity Type:Individual
Prefix:
First Name:ALEAH
Middle Name:M
Last Name:SISITKI
Suffix:
Gender:F
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:N16088 BALSAM LANE
Mailing Address - Street 2:
Mailing Address - City:SPALDING
Mailing Address - State:MI
Mailing Address - Zip Code:49886
Mailing Address - Country:US
Mailing Address - Phone:906-497-5263
Mailing Address - Fax:
Practice Address - Street 1:N16088 BALSAM LANE
Practice Address - Street 2:
Practice Address - City:SPALDING
Practice Address - State:MI
Practice Address - Zip Code:49886
Practice Address - Country:US
Practice Address - Phone:906-497-5263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-13
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601005687363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant