Individual
MICHAEL JAMES CHURCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
6308 8TH AVE, KENOSHA, WI 53143-5031
(262) 656-2011
Mailing address
3108 MARKET LN APT 804, KENOSHA, WI 53144-3463
(616) 295-5062
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5119-23
WI
363AM0700X
Medical Physician Assistant
5119-23
WI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
02/23/2020
Last updated
09/02/2020
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