Provider Demographics
NPI:1528133451
Name:PLOCINIK, MICHAEL JOHN (PA)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JOHN
Last Name:PLOCINIK
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:80600 VAN DYKE RD
Mailing Address - Street 2:
Mailing Address - City:BRUCE TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48065-1333
Mailing Address - Country:US
Mailing Address - Phone:810-798-6560
Mailing Address - Fax:810-798-6563
Practice Address - Street 1:80600 VAN DYKE RD
Practice Address - Street 2:
Practice Address - City:BRUCE TWP
Practice Address - State:MI
Practice Address - Zip Code:48065-1333
Practice Address - Country:US
Practice Address - Phone:810-798-6560
Practice Address - Fax:810-798-6563
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5601004489363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI11468621OtherAETNA
MI11468621OtherAETNA