Provider Demographics
NPI:1548658644
Name:LOPRESTO, ASHLEY (PA-C)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:LOPRESTO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:
Other - Last Name:POLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2000 GREEN RD, STE 300
Mailing Address - Street 2:EMERGENCY PHYSICIANS MEDICAL GROUP
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105
Mailing Address - Country:US
Mailing Address - Phone:734-686-6322
Mailing Address - Fax:734-686-6322
Practice Address - Street 1:2000 GREEN RD, STE 300
Practice Address - Street 2:EMERGENCY PHYSICIANS MEDICAL GROUP
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105
Practice Address - Country:US
Practice Address - Phone:734-686-6322
Practice Address - Fax:734-686-6322
Is Sole Proprietor?:No
Enumeration Date:2014-12-26
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AM0700X
MI5601007289363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant