Provider Demographics
NPI:1447685102
Name:SUMMERVILLE, ANDREW J (PA)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:J
Last Name:SUMMERVILLE
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:1234 NAPIER AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-2112
Mailing Address - Country:US
Mailing Address - Phone:269-985-4632
Mailing Address - Fax:269-985-4623
Practice Address - Street 1:1234 NAPIER AVE
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-2112
Practice Address - Country:US
Practice Address - Phone:269-985-4632
Practice Address - Fax:269-985-4623
Is Sole Proprietor?:No
Enumeration Date:2013-09-12
Last Update Date:2015-01-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5601006750363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant