Individual
JAE MICHAEL GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
601 JOHN ST, SUITE M424, KALAMAZOO, MI 49007-5341
(269) 349-3350
(269) 349-2403
Mailing address
601 JOHN ST, SUITE M424, KALAMAZOO, MI 49007-5341
(269) 349-3350
(269) 349-2403
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601005905
MI
363AS0400X
Surgical Physician Assistant
5601005905
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5601005905
MICHIGAN STATE LICENSE
MI
Enumeration date
10/20/2010
Last updated
12/15/2020
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