Basic Information
Provider Information
NPI: 1639301724
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: APPLEBEY
FirstName: RONALD
MiddleName: FRANK
NamePrefix:  
NameSuffix:  
Credential: PA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 829 N CENTER AVE
Address2: SUITE 298
City: GAYLORD
State: MI
PostalCode: 497351595
CountryCode: US
TelephoneNumber: 9897317708
FaxNumber: 9897317929
Practice Location
Address1: 829 N CENTER AVE
Address2: SUITE 210
City: GAYLORD
State: MI
PostalCode: 497351595
CountryCode: US
TelephoneNumber: 9897317860
FaxNumber: 9897317833
Other Information
ProviderEnumerationDate: 08/22/2009
LastUpdateDate: 11/15/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363A00000X5601005566MIY Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 

No ID Information.


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