Provider Demographics
NPI:1043940968
Name:PEER, MICHAEL SHANE (PA-C)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:SHANE
Last Name:PEER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5086 PARKGATE DR
Mailing Address - Street 2:
Mailing Address - City:COMMERCE TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48382-1499
Mailing Address - Country:US
Mailing Address - Phone:313-806-0039
Mailing Address - Fax:
Practice Address - Street 1:5086 PARKGATE DR
Practice Address - Street 2:
Practice Address - City:COMMERCE TWP
Practice Address - State:MI
Practice Address - Zip Code:48382-1499
Practice Address - Country:US
Practice Address - Phone:313-806-0039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-14
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1195995363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1195995OtherNCCPA