Staff, Mike

Staff, Mike is an individual health care provider with primary practice located at 2601 W Main St , Carbondale IL 62901-1031. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as his primary health care specialty. Staff, Mike can be contacted via phone (618) 549-5361.

Contact Information

Primary practice address
2601 W Main St Carbondale IL 62901-1031
Phone: (618) 549-5361
Fax: (618) 549-5128
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 085-000618 Illinois

Profile Details

NPI number 1326104290
LBN Legal business name Staff, Mike
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 28th, 2006
Last updated Jul 11th, 2011 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1326104290 NPPES
Illinois Other 7210895 AETNA
Illinois Other 028748 AETNA
Illinois Other 3932056 AETNA

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