Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 5101012099 | MI |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 5101011299 | MI |
NPI | 1619199171 |
---|---|
Provider Name | Dr. Jann E. Trzeciak |
First Address | Lapeer, MI 48446-0685 |
Second Address | Pontiac, MI 48340 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2007 |
Last Update Date | 20/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1619199171 | (05) | MI |
JT012099 | BCBS (01) | MI |
MI1503014 | (02) | MI |
MI1504014 | (02) | MI |