Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 4301052662 | MI |
Y | 207PE0004X | Emergency Medical Services | 4301052662 | MI |
N | 207PP0204X | Pediatric Emergency Physician | 4301052662 | MI |
NPI | 1508844200 |
---|---|
Provider Name | Dr. Joyce M Blazejewski |
First Address | Long Beach, CA 90802-4317 |
Second Address | Dearborn, MI 48126-3698 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2006 |
Last Update Date | 01/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F10094 | (02) | MI |