Individual
MICAH LEE SERVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
SA-C
Contact information
Practice address
747 N RUTLEDGE ST, 5TH FLOOR, SPRINGFIELD, IL 62702-6700
(217) 545-5878
(217) 545-2586
Mailing address
PO BOX 19679, SPRINGFIELD, IL 62794-9679
(217) 545-5878
(217) 545-2586
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
238-000264
IL
Other
Enumeration date
10/27/2010
Last updated
10/27/2010
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