Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 4704349990 | MI |
NPI | 1013673581 |
---|---|
Provider Name | Jonathan Michael Fleezanis |
First Address | Northville, MI 48167-2827 |
Second Address | Novi, MI 48375-2947 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2021 |
Last Update Date | 09/11/2021 |