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Individual
MICHELLE L MARDEGIAN
Active
Individual
MICHELLE L MARDEGIAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601002219
MI
363AM0700X
Medical Physician Assistant
5601002219
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MM002219
MI LICENSE NUMBER
MI
Enumeration date
03/20/2007
Last updated
07/31/2023
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