NPI 1801121348

Ethel Mbombow, PAC

Practitioner Physician Assistant Eastpointe, MI

Practice location

Address: 21409 Kelly Rd Suite 400, Eastpointe, MI 48021-3264
Phone: (586) 777-0630
Fax: (586) 777-0631
Mailing address: 4967 Crooks Rd STE 130, Troy, MI 48098-5801

Registered specialties (3)

Physician Assistant Primary

Physician Assistants & Advanced Practice Nursing Providers Taxonomy 363A00000X Licence 5601005700 (MI)

Other Physician Assistant providers in Michigan →

Internal Medicine Physician

Allopathic & Osteopathic Physicians Taxonomy 207R00000X Licence 1088784 (MI)

Other Internal Medicine providers in Michigan →

Internal Medicine Physician

Allopathic & Osteopathic Physicians Taxonomy 207R00000X Licence 5601005700 (MI)

Registry record

NPI: 1801121348
Entity type: Individual
Sex (as registered): Female
NPI issued: 15 Oct 2009
Record last updated: 29 Jul 2015

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.