Individual
CANDACE ATISHA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
37669 PEMBROKE AVE, LIVONIA, MI 48152-1050
(734) 793-6500
Mailing address
37669 PEMBROKE AVE, LIVONIA, MI 48152-1050
(734) 793-6500
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
5601007299
MI
Other
Enumeration date
02/26/2015
Last updated
03/13/2015
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