Individual
BOE L BISSETT
Active
Individual
BOE L BISSETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
5601006255
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5601006255
STATE OF MICHIGAN LICENSE
MI
Enumeration date
01/13/2012
Last updated
01/13/2012
Update your record
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