| Doctor Name: | SONYA C CAMILLI |
| NPI Number: | 1154328573 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PA-C |
| License Number: | 5601004803 |
| Business Practice Address: | 7 N Atkinson Dr Ste 113 Ludington, MI - 494311953 |
| Business Phone Number: | 2318433700 |
| Business Fax Number: | 2318434525 |
| Mailing Address: | 100 Michigan St Ne # Mc845, GRAND RAPIDS |
| State: | MI |
| Postal Code: | 495032560 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 06/30/2005 |
| NPI Last Update Date: | 02/01/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 5601004803 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |