Provider Demographics
NPI:1801870266
Name:PASIA, EDGAR NEIL (DO)
Entity type:Individual
Prefix:
First Name:EDGAR
Middle Name:NEIL
Last Name:PASIA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O BOX 5031
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48061-5031
Mailing Address - Country:US
Mailing Address - Phone:810-985-4900
Mailing Address - Fax:810-985-3634
Practice Address - Street 1:940 RIVER CENTRE DR.
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060
Practice Address - Country:US
Practice Address - Phone:810-985-4900
Practice Address - Fax:810-985-3634
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY02896207XS0117X
MI5101016691207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MII37575Medicare UPIN
MI0G46008010Medicare PIN