Basic Information
Provider Information
NPI: 1821441882
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FLEMING
FirstName: AARON
MiddleName: M.
NamePrefix:  
NameSuffix:  
Credential: NP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 10850 E TRAVERSE HWY
Address2: SUITE 4400
City: TRAVERSE CITY
State: MI
PostalCode: 496841364
CountryCode: US
TelephoneNumber: 2313466800
FaxNumber: 9893401214
Practice Location
Address1: 1721 S STEPHENSON AVE
Address2:  
City: IRON MOUNTAIN
State: MI
PostalCode: 498013637
CountryCode: US
TelephoneNumber: 9067741313
FaxNumber: 9893401214
Other Information
ProviderEnumerationDate: 07/14/2016
LastUpdateDate: 01/23/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 01/23/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X4704273914MIY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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