Individual
BETHANY LYNN PARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
27177 LAHSER RD, SOUTHFIELD, MI 48034-4714
(989) 277-6478
Mailing address
1521 ROYAL OAK ST SW, WYOMING, MI 49509-2711
(989) 277-6478
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601012241
MI
Other
Enumeration date
02/13/2024
Last updated
02/13/2024
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