MICAH LEE SERVIS (NPI# 1467752220) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1467752220 |
| Entity Type | Individual |
| Full Name | MICAH LEE SERVIS |
| Credential | SA-C |
| Practice Address |
747 N Rutledge St 5th Floor Springfield IL 62702-6700 |
| Mailing Address |
Po Box 19679 Springfield IL 62794-9679 |
| Practice Telephone | 2175455878 |
| Practice Fax Number | 2175452586 |
| Mailing Telephone | 2175455878 |
| Mailing Fax Number | 2175452586 |
| Enumeration Date | 2010-10-27 |
| Last Update Date | 2010-10-27 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
238-000264 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
747 N RUTLEDGE ST 5TH FLOOR |
| City | SPRINGFIELD |
| State | IL |
| Zip Code | 62702-6700 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619974532 | Neha N Amin | Obstetrics & Gynecology | 747 N Rutledge St, Baylis Building, 2nd Floor, Springfield, IL 62702-6700 | 2005-07-07 |
| 1295343648 | Katherine G Brockhouse | Nurse Practitioner | 747 N Rutledge St, Springfield, IL 62702-6700 | 2020-07-21 |
| 1376151258 | Lauren Woldanski | Plastic Surgery | 747 N Rutledge St, Springfield, IL 62702-6700 | 2020-07-16 |
| 1356968358 | Jessie Laina Koljonen | Plastic Surgery | 747 N Rutledge St, Springfield, IL 62702-6700 | 2020-06-25 |
| 1487274882 | Tiffany Lynn Damm | Urology | 747 N Rutledge St, Springfield, IL 62702-6700 | 2020-04-26 |
| 1811516065 | Jazzmyne T Montgomery | Urology | 747 N Rutledge St, Springfield, IL 62702-6700 | 2020-04-08 |
| 1639738644 | Alexis Ruffolo | Plastic Surgery | 747 N Rutledge St, Springfield, IL 62702-6700 | 2019-06-12 |
| 1922667930 | Justin D Sawyer | Plastic Surgery | 747 N Rutledge St, Springfield, IL 62702-6700 | 2019-06-12 |
| 1174016950 | Michael Romanelli | Plastic Surgery | 747 N Rutledge St, Springfield, IL 62702-6700 | 2018-06-07 |
| 1902398357 | William James Bruce | Plastic Surgery | 747 N Rutledge St, Springfield, IL 62702-6700 | 2018-06-01 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457866519 | Mohammad Jamal Uddin Ansari | Internal Medicine | 751 N Rutledge St Ste 400, Springfield, IL 62702 | 2017-12-11 |
| 1588105811 | Mickey Graphia | Surgery | 701 N 1st St # D346, Springfield, IL 62702 | 2017-03-20 |
| 1376908913 | Abdul Hannan | Internal Medicine | 315 W Carpenter St # B, Springfield, IL 62702 | 2015-12-28 |
| 1871986414 | Rachel Hoselton | Nurse Practitioner | 400 N 9th St Fl 4, Springfield, IL 62702 | 2015-03-06 |
| 1548697774 | Alyssa Wilson | Behavioral Analyst | 232 Bruns Lane, One Sparcenter Plaza, Springfield, IL 62702 | 2013-10-02 |
| 1174965446 | Amy Wilson | Speech-Language Pathologist | 2120 West Washington Street, Springfield, IL 62702 | 2013-07-26 |
| 1275898116 | Pele Boutrous Dina | Pediatrics | 415 N 9th St # 4w16, Springfield, IL 62702 | 2012-07-06 |
| 1427327733 | Brook D Croke | Genetic Counselor, MS | 400 N. 9th Street, 3rd Floor Clinic B, Springfield, IL 62702 | 2011-12-16 |
| 1629352604 | Renae M Sanchez | Pharmacist | 3216 East Clearlake Ave, Springfield, IL 62702 | 2011-10-07 |
| 1982915302 | William Leland Zelkovich | Radiology | 701 N 1st, Springfield, IL 62702 | 2010-06-30 |
| Find all providers in zip 62702 | ||||
| Taxonomy Code | 363AS0400X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Surgical Technologist |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629592225 | Justin William Starling | Physician Assistant | 1515 Keys Ave, Springfield, IL 62702-2933 | 2017-07-26 |
| 1710435011 | Alexander Andersen | Physician Assistant | 445 Harlow Rd Ste 200, Springfield, OR 97477-1341 | 2016-09-14 |
| 1932538980 | Emily Baecher | Physician Assistant | 2 Medical Cetner Dr, Suite 205, Springfield, MA 01199-1619 | 2013-11-09 |
| 1699114421 | Lauren M Kendall | Physician Assistant | 960 N 16th St Ste 108, Springfield, OR 97477-4175 | 2013-06-14 |
| 1750660148 | Daniel Francis Reilly Jr. | Physician Assistant | 2 Medical Center Dr Ste 308, Springfield, MA 01107-1271 | 2011-08-16 |
| 1831499383 | Christin Wolak | Physician Assistant | 300 Birnie Ave Ste 201, Springfield, MA 01107-1121 | 2010-11-01 |
| 1811200710 | Jessica Anne White | Physician Assistant | 25 Ridgewood Rd., Esne, Springfield, VT 05156 | 2010-07-20 |
| 1043540669 | Kristen Dawn Dodd | Physician Assistant | 960 N 16th St Ste 207, Springfield, OR 97477-4175 | 2010-01-04 |
| 1831337765 | Cynthia R. Krinochkin | Physician Assistant | 3801 S. National, 5th Floor, Springfield, MO 65807-5210 | 2009-01-30 |
| 1578746079 | Jamie Moore | Physician Assistant | 2 Medical Center Drive Suite 503, Springfield, MA 01199-0001 | 2007-12-07 |
| Find all providers in SPRINGFIELD | ||||
| City | SPRINGFIELD |
| Zip Code | 62702 |
Please comment or provide details below to improve the information on MICAH LEE SERVIS.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.