Judith Mestnik Gray, PA
Individual provider Active NPI Physician Assistant · Negaunee, MI
NPI 1821150327 · NPPES record last updated Apr 5, 2022
Key facts
- NPI
- 1821150327
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 5601001085 (MI)
- Practice address
- 104 Malton Rd
Negaunee, MI 49866-2000 - Phone
- (906) 228-4692
- Fax
- (906) 228-2830
- NPI assigned
- Dec 14, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 6
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050701000173 | MI | Practitioner - Physician Assistant | 1951347723 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5601001085 | MI | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bell Medical Center | Current |
Accepting new patients | |
| Bell Physician Practices Inc | Current |
Accepting new patients | |
| Great Lakes Recovery Centers | Past |
Accepting new patients | |
| Great Lakes Recovery Centers | Past |
Accepting new patients | |
| Great Lakes Recovery Centers | Past |
Accepting new patients |
Locations
97 S 4th St
Ste F
Ishpeming, MI 49849
Phone (906) 458-2347
97 S 4th St
Ste B
Ishpeming, MI 49849
Phone (906) 485-1037
901 Lakeshore Dr
Ishpeming, MI 49849
Phone (906) 485-2653
100 Malton Rd
Ste 7
Negaunee, MI 49866
Phone (906) 464-0002
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 5601001085 | MI | Yes |
Addresses
Primary practice location
104 Malton Rd
Negaunee, MI 49866-2000
Mailing address
97 S 4TH St Ste C
Ishpeming, MI 49849-2168
Phone (906) 228-9699
Other practice location 1
241 Wright St
Marquette, MI 49855-1955
Phone (906) 228-7611
Other practice location 2
1009 W Ridge St Ste C
Marquette, MI 49855-3997
Phone (906) 228-6545
Other practice location 3
100 Malton Rd Ste 7
Negaunee, MI 49866-2002
Phone (906) 464-0002
Other practice location 4
97 S 4th St Ste B
Ishpeming, MI 49849-2168
Phone (906) 464-0002
Other providers in Negaunee, MI
- Benjamin Aron Nicolas Gilmore
- Jenna Rae Giordana
- Joni Marie Gleason
- Terry L Gould
- Kyra Granroth
- Great Lakes Recovery Centers
- Great Lakes Recovery Centers
- Great Lakes Recovery Centers
- Great Lakes Recovery Centers
- Great Lakes Recovery Centers
All providers in Negaunee, 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 Apr 5, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.