Provider Demographics
NPI:1548353378
Name:MESSIMER, STEPHEN R (PA)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:R
Last Name:MESSIMER
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:2864 ASHMUN STREET
Mailing Address - Street 2:SAULT TRIBAL HEALTH CENTER
Mailing Address - City:SAULT SAINTE MARIE
Mailing Address - State:MI
Mailing Address - Zip Code:49783
Mailing Address - Country:US
Mailing Address - Phone:906-632-5200
Mailing Address - Fax:906-632-5276
Practice Address - Street 1:6596 W US HIGHWAY 2
Practice Address - Street 2:MANISTIQUE TRIBAL HEALTH CENTER
Practice Address - City:MANISTIQUE
Practice Address - State:MI
Practice Address - Zip Code:49584
Practice Address - Country:US
Practice Address - Phone:906-341-8469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5601001346363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant