Gayle Anne Antonelli, PA-C
Individual provider Active NPI Physician Assistant · Manchester, MI
NPI 1720248016 · NPPES record last updated Jun 11, 2008
Key facts
- NPI
- 1720248016
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 5601002116 (MI)
- Practice address
- 122 W Main St
Manchester, MI 48158-1002 - Phone
- (734) 428-8381
- Fax
- (734) 428-9066
- NPI assigned
- Jun 11, 2008
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5601002116 | MI | MD | Physician Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 5601002116 | MI | Yes |
Addresses
Primary practice location
122 W Main St
Manchester, MI 48158-1002
Mailing address
122 W Main St
Manchester, MI 48158-1002
Phone (734) 428-8381
Other providers in Manchester, MI
- Amy Akasheh
- Andrews Family Chiropractic PLLC
- Dana Ray Andrews
- Jean Ann Armstrong
- Bruce Alan Bates
- Rebecca Marie Beery
- Bridgewater Support Services, LLC
- Amber Dawn Burkhardt-Sidebottom
All providers in Manchester, MI · Physician Assistant in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 11, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.