Basic Information
| Provider Information | |||||||||
| NPI: | 1548353378 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | MESSIMER | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2864 ASHMUN STREET | ||||||||
| Address2: | SAULT TRIBAL HEALTH CENTER | ||||||||
| City: | SAULT SAINTE MARIE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 49783 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9066325200 | ||||||||
| FaxNumber: | 9066325276 | ||||||||
| Practice Location | |||||||||
| Address1: | 6596 W US HIGHWAY 2 | ||||||||
| Address2: | MANISTIQUE TRIBAL HEALTH CENTER | ||||||||
| City: | MANISTIQUE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 49584 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9063418469 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 5601001346 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.