Individual
BRENT SIMON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
204 W 3RD ST, PINCONNING, MI 48650-9622
(989) 879-3771
(989) 879-3788
Mailing address
1003 WOODSIDE AVE, ESSEXVILLE, MI 48732-1234
(989) 892-7722
(989) 892-7455
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601006442
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1326397993
—
MI
01
—
MI1566
PTAN GROUP
MI
Enumeration date
08/29/2012
Last updated
02/12/2013
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