Provider Demographics
NPI:1871603449
Name:DE PUE, CLARE (PA-C)
Entity type:Individual
Prefix:MR
First Name:CLARE
Middle Name:
Last Name:DE PUE
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 1:1414 W FAIR AVE
Mailing Address - Street 2:SUITE 134
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-2675
Mailing Address - Country:US
Mailing Address - Phone:906-226-2233
Mailing Address - Fax:906-226-2409
Practice Address - Street 1:1414 W FAIR AVE
Practice Address - Street 2:STE 134
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-2675
Practice Address - Country:US
Practice Address - Phone:906-226-2233
Practice Address - Fax:906-226-2409
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601001211363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5601001211OtherMI STATE MEDICAL LICENSE
MIMO096832OtherDEA
R68642Medicare UPIN