Individual
PAUL ANDREW MAHONEY II
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
A.T.,C. L.A.T.
Contact information
Practice address
6319 COUNTY LINE RD, IRA, MI 48023-1003
(586) 648-2528
Mailing address
36668 CATALPA LN, NEW BALTIMORE, MI 48047-5578
(586) 612-5120
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2601000611
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
049302490
BOARD OF CERTIFICATION INC. (BOC)
—
01
—
2601000611
STATE OF MICHIGAN DEPARTMENT OF COMMUNITY HEALTH
MI
Enumeration date
01/04/2019
Last updated
01/04/2019
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