| Yassa Pac LLC | |
|
624 E 9 Mile Rd Hazel Park MI 48030-1842 | |
| (248) 629-7497 | |
| Not Available |
| Full Name | Yassa Pac LLC |
|---|---|
| Speciality | Clinic/center |
| Location | 624 E 9 Mile Rd, Hazel Park, Michigan |
| Authorized Official Name and Position | Marcos Yassa (PA-C) |
| Authorized Official Contact | 2486297497 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Yassa Pac LLC Po Box 366 Hazel Park MI 48030-0366 Ph: (248) 629-7497 | Yassa Pac LLC 624 E 9 Mile Rd Hazel Park MI 48030-1842 Ph: (248) 629-7497 |
| NPI Number | 1962016360 |
|---|---|
| Provider Enumeration Date | 09/02/2020 |
| Last Update Date | 12/16/2020 |
| Certification Date | 12/16/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962016360 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (NU) | Primary |
| 363A00000X | Physician Assistant | (NU) | Secondary |
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