| Ms Bonnie Merritt Wallace, PA-C | |
|
3304 Cooley Ct, Portage, MI 49024-7430 | |
| (269) 349-2266 | |
| (269) 349-0792 |
| Full Name | Ms Bonnie Merritt Wallace |
|---|---|
| Gender | Female |
| Speciality | Physician Assistant |
| Location | 3304 Cooley Ct, Portage, Michigan |
| Accepts Medicare Assignments | Does not participate in Medicare Program. She may not accept medicare assignment. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437402229 | NPI | - | NPPES |
| 1437402229 | Medicaid | MI | |
| 5601006513 | Other | MI | PHYSICIAN'S ASSISTANT LICENSE |
| 1417961137 | Other | MI | BCBSM - BMH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 363A00000X | Physician Assistant | 5601006513 (Michigan) | Primary |
| Mailing Address | Practice Location Address |
|---|---|
| Ms Bonnie Merritt Wallace, PA-C 3304 Cooley Ct, Portage, MI 49024-7430 Ph: (269) 349-2266 | Ms Bonnie Merritt Wallace, PA-C 3304 Cooley Ct, Portage, MI 49024-7430 Ph: (269) 349-2266 |
Gina Marie O'callaghan, PA-C Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 3000 Old Centre Rd, Portage, MI 49024 Phone: 269-321-7546 Fax: 269-321-1705 | |
Brittany Rose Doxey, PA-C Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 1324 W Milham Ave, Portage, MI 49024 Phone: 269-342-0196 | |
Madison Lynn Van Winkle, PA-C Physician Assistant Medicare: Not Enrolled in Medicare Practice Location: 1151 W Milham Ave Unit 758, Portage, MI 49081 Phone: 516-710-0979 | |
Stephanie Sabater-geib, PA-C Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 3000 Old Centre Rd, Portage, MI 49024 Phone: 269-321-7546 Fax: 269-321-1705 | |
Pamela Bartley, Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 7901 Angling Rd, Portage, MI 49024 Phone: 269-324-8600 | |
Brooke Osborne Boyd, PA-C Physician Assistant Medicare: Medicare Enrolled Practice Location: 3000 Old Centre Rd, Portage, MI 49024 Phone: 269-321-7546 Fax: 269-321-1705 | |
Therese A Birkam-jade, PA-C Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 6100 Newport Rd, Suite 100, Portage, MI 49002 Phone: 269-343-4679 Fax: 269-343-5929 |