Individual
JESSICA PANOFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
116 W MITCHELL ST, PETOSKEY, MI 49770-2357
(231) 348-2828
(231) 348-9609
Mailing address
116 W MITCHELL, PETOSKEY, MI 49770-2357
(231) 348-2828
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
5601007439
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1548639560
—
MI
Enumeration date
09/21/2015
Last updated
12/18/2020
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