Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0201X | Internist - Allergy & Immunology | 4301067218 | MI |
NPI | 1124018296 |
---|---|
Provider Name | Dr. Jane E Krasnick |
First Address | Warren, MI 48093-1700 |
Second Address | Warren, MI 48093 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2005 |
Last Update Date | 02/08/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
030005365 | RAILROAD MEDICARE (01) | MI |
030500426 | BCBS (01) | MI |
030500426 | BCN (01) | MI |
4450085 | (05) | MI |
G39644 | (02) | |
G39644 | HAP (01) | MI |