Provider Demographics
NPI:1770796088
Name:GREENWAY, STEVEN MICHAEL (PA-C)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:MICHAEL
Last Name:GREENWAY
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 1:12247 EYER DR NE
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48838-8340
Mailing Address - Country:US
Mailing Address - Phone:616-225-8209
Mailing Address - Fax:
Practice Address - Street 1:800 S MAPLEWOOD DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MI
Practice Address - Zip Code:48838-3556
Practice Address - Country:US
Practice Address - Phone:616-225-9369
Practice Address - Fax:616-225-9838
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601002496363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0855900995OtherBCBS
MI5601002496OtherLICENSE NUMBER
MI0P08190Medicare PIN
MIH49010Medicare UPIN