Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Mr. Mitchell John Fogal, PA-C

Individual provider Physician Assistant · NPI 1407101538

Mr. Mitchell John Fogal, PA-C is a Physician Assistant in Holland, Michigan. Qualified in 2012, 14 years ago. Practices with Shoreline Orthopaedic and Sports Medicine Clinic P L C, a 25-clinician group and accepts Medicare assignment. Licensed in Michigan.

Years since qualifying
14
Licensed in
MI
In the registry since
2012
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

370 N 120th Ave Ste 20
Holland, MI 49424-2196
Phone: (616) 396-5855
Fax: (877) 592-0688
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 5601011747 (MI)

Record details

NPI number1407101538
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorNo
NPI enumeratedJuly 15, 2012
Last updated in NPPESOctober 10, 2025
Certification dateOctober 10, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2012 (14 years in practice)
Group practice Shoreline Orthopaedic And Sports Medicine Clinic P L C — 25 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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