Active NPI
Leon B Papendick, PA
- Medical Physician Assistant
- Galesburg, MI
National Provider Identifier
1790892305
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- 5601003929
- Practice address
- 9880 E Michigan Ave
Suite 100
Galesburg, MI 49053-8641 - Phone
- (269) 665-7092
- Fax
- (269) 665-7097
- NPI assigned
- Aug 23, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 5601003929 | MI | Primary |
Addresses
Primary practice location
9880 E Michigan Ave
Suite 100
Galesburg, MI 49053-8641
Mailing address
7679 North 30TH Street
Richland, MI 49083
Phone (269) 629-5177
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5601003929 | MI | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156291200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1192060800000",
"number": "1790892305",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7679 NORTH 30TH STREET",
"city": "RICHLAND",
"state": "MI",
"postal_code": "49083",
"telephone_number": "269-629-5177"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9880 E MICHIGAN AVE",
"address_2": "SUITE 100",
"city": "GALESBURG",
"state": "MI",
"postal_code": "490538641",
"telephone_number": "269-665-7092",
"fax_number": "269-665-7097"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PAPENDICK",
"first_name": "LEON",
"middle_name": "B",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-23",
"last_updated": "2007-10-11",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "MI",
"license": "5601003929",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Galesburg, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.