Individual
MICHAEL LUCAS BRASEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1777 ELLIS AVE, JACKSON, MS 39204-3616
(601) 371-0400
Mailing address
4092 HIGHWAY 472, HAZLEHURST, MS 39083-9650
(601) 894-4825
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA00197
MS
Other
Enumeration date
01/30/2014
Last updated
01/30/2014
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